Individual
MRS. LYDIA M. STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1225 N WEST ST, JACKSON, MS 39202-2056
(601) 540-7105
Mailing address
1820 HIGHWAY 80 WEST, JACKSON, MS 39204-2056
(601) 540-7105
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C0715
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120550
—
MS
Enumeration date
05/12/2007
Last updated
05/25/2012
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