Provider Demographics
NPI:1811603277
Name:LOTT, VERQUISHALA SHENNAE (MHA)
Entity type:Individual
Prefix:
First Name:VERQUISHALA
Middle Name:SHENNAE
Last Name:LOTT
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:VERQUISHALA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3123 CARLOTTA RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3956
Mailing Address - Country:US
Mailing Address - Phone:904-403-5093
Mailing Address - Fax:
Practice Address - Street 1:6266 DUPONT STATION CT E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2567
Practice Address - Country:US
Practice Address - Phone:904-745-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health