Provider Demographics
NPI:1255749487
Name:MABRY, LAWANA JACKSON (LCSW-BACS)
Entity type:Individual
Prefix:DR
First Name:LAWANA
Middle Name:JACKSON
Last Name:MABRY
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:LAWANA
Other - Middle Name:MICHELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10632 HOLLY HOCK DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-5312
Mailing Address - Country:US
Mailing Address - Phone:985-241-1924
Mailing Address - Fax:985-616-1023
Practice Address - Street 1:10632 HOLLY HOCK DR
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-5312
Practice Address - Country:US
Practice Address - Phone:985-241-1924
Practice Address - Fax:985-616-1023
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical