Provider Demographics
NPI:1902437734
Name:GALE, LASHAUNDRA DENISE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LASHAUNDRA
Middle Name:DENISE
Last Name:GALE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:LASHAUNDRA
Other - Middle Name:DENISE
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MSW
Mailing Address - Street 1:89 COUNTY ROAD 108
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38601
Mailing Address - Country:US
Mailing Address - Phone:662-607-4643
Mailing Address - Fax:
Practice Address - Street 1:152 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5392
Practice Address - Country:US
Practice Address - Phone:662-234-7521
Practice Address - Fax:662-236-3071
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW7054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health