Provider Demographics
NPI:1659140465
Name:CISTRUNK, LAQUNANA WILLIAMS (LCSW, LISW)
Entity type:Individual
Prefix:
First Name:LAQUNANA
Middle Name:WILLIAMS
Last Name:CISTRUNK
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:LAQUNANA
Other - Middle Name:
Other - Last Name:CISTRUNK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LISW
Mailing Address - Street 1:1027 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2725
Mailing Address - Country:US
Mailing Address - Phone:812-538-9088
Mailing Address - Fax:
Practice Address - Street 1:3502 W NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-4454
Practice Address - Country:US
Practice Address - Phone:601-362-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1336861041C0700X
MSC-114801041C0700X
RICSW040311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical