Provider Demographics
NPI:1104166404
Name:DECKER, KASSANDRA (LPC)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 OAK LN
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-2760
Mailing Address - Country:US
Mailing Address - Phone:662-640-2069
Mailing Address - Fax:901-221-1533
Practice Address - Street 1:1904 OAK LN
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2760
Practice Address - Country:US
Practice Address - Phone:662-640-2069
Practice Address - Fax:901-221-1533
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS2037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health