Provider Demographics
NPI:1568673341
Name:LIGHTFOOT, LASONJA L (MS)
Entity Type:Individual
Prefix:
First Name:LASONJA
Middle Name:L
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CARLETON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2703
Mailing Address - Country:US
Mailing Address - Phone:601-572-3700
Mailing Address - Fax:607-572-3701
Practice Address - Street 1:805 S WHEATLEY ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5000
Practice Address - Country:US
Practice Address - Phone:601-572-3700
Practice Address - Fax:601-572-3701
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor