Provider Demographics
NPI:1396114161
Name:DANDRIDGE-CLARK, KRISTY LASHAWN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LASHAWN
Last Name:DANDRIDGE-CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LASHAWN
Other - Last Name:DANDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-1310
Practice Address - Street 1:29437 HIGHWAY 63
Practice Address - Street 2:STE. 14
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-7075
Practice Address - Country:US
Practice Address - Phone:225-283-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6147OtherSTATE OF LOUISIANA LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS