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1679788616
LYDIA M. STATEN
JACKSON, MS
NPI
1679788616
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Former Name
LYDIA ELEANOR MILLWOOD
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: MS C0715)
Enumeration Date
2007-05-12
Last Update Date
2012-05-25
Business Address
Mrs. LYDIA M. STATEN LCSW
1225 N WEST ST
JACKSON, MS 39202-2056
Phone number: 601-540-7105
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Mailing Address
Mrs. LYDIA M. STATEN LCSW
1820 HIGHWAY 80 WEST
JACKSON, MS 39204-2056
Phone number: 601-540-7105
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