Provider Demographics
NPI:1790984649
Name:BISHOP, LEONA DEMETHIA (MED, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEONA
Middle Name:DEMETHIA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HAWTHORN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1545
Mailing Address - Country:US
Mailing Address - Phone:601-832-2956
Mailing Address - Fax:
Practice Address - Street 1:4500 I-55 NORTH
Practice Address - Street 2:HIGHLAND VILLAGE- SUITE 220
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-832-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0594101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor