Provider Demographics
NPI:1437750478
Name:CAVETT, LATIBBIE (LPC)
Entity Type:Individual
Prefix:DR
First Name:LATIBBIE
Middle Name:
Last Name:CAVETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BRIARWOOD DR STE 108F
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3032
Mailing Address - Country:US
Mailing Address - Phone:601-517-2667
Mailing Address - Fax:
Practice Address - Street 1:405 BRIARWOOD DR STE 108F
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3032
Practice Address - Country:US
Practice Address - Phone:601-517-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2022-11-21
Deactivation Date:2022-11-17
Deactivation Code:
Reactivation Date:2022-11-21
Provider Licenses
StateLicense IDTaxonomies
MS2631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional