1659140465 NPI number — LAQUNANA WILLIAMS CISTRUNK LCSW, LISW

Table of content: LAQUNANA WILLIAMS CISTRUNK LCSW, LISW (NPI 1659140465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659140465 NPI number — LAQUNANA WILLIAMS CISTRUNK LCSW, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CISTRUNK
Provider First Name:
LAQUNANA
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CISTRUNK
Provider Other First Name:
LAQUNANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, LISW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659140465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
272 CALHOUN STATION PARKWAY, SUITE C PMB
Provider Second Line Business Mailing Address:
1165
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
769-218-2637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3502 W NORTHSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39213-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-362-5321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  12671-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 133686 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C-11480 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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