Provider Demographics
NPI:1245462977
Name:CROSON, JUANDA (LPC)
Entity type:Individual
Prefix:
First Name:JUANDA
Middle Name:
Last Name:CROSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JUANDA
Other - Middle Name:L
Other - Last Name:CROSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:181 N WINDRIDGE LANE APT A
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475
Mailing Address - Country:US
Mailing Address - Phone:504-541-4924
Mailing Address - Fax:
Practice Address - Street 1:423 WEATHERSBY RD STE 150
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1132
Practice Address - Country:US
Practice Address - Phone:504-541-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1391101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health