Provider Demographics
NPI:1568594810
Name:CARAWAY, LIDA P (MA MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:P
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:MA MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 CRANE RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4944
Mailing Address - Country:US
Mailing Address - Phone:601-951-3131
Mailing Address - Fax:
Practice Address - Street 1:1855 CRANE RIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4944
Practice Address - Country:US
Practice Address - Phone:601-951-3131
Practice Address - Fax:601-951-3131
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional