Provider Demographics
NPI:1639567282
Name:CLARK, LASHUNDRA (LPC)
Entity Type:Individual
Prefix:DR
First Name:LASHUNDRA
Middle Name:
Last Name:CLARK
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 1:315 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4717
Mailing Address - Country:US
Mailing Address - Phone:601-488-4852
Mailing Address - Fax:601-488-4091
Practice Address - Street 1:315 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4717
Practice Address - Country:US
Practice Address - Phone:601-488-4852
Practice Address - Fax:601-488-4091
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS2384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07578542Medicaid