MEDICARE: STEP UP COUNSELING & CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235499351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP UP COUNSELING & CONSULTING

Provider Business Mailing Address
First Line	:	2628 SOUTHERLAND ST
Second Line	:	SUITE D
City	:	JACKSON
State	:	MS
Zip	:	39216-4825
Country	:	US
Telephone Number	:	601-826-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2628 SOUTHERLAND ST
Second Line	:	SUITE D
City	:	JACKSON
State	:	MS
Zip	:	39216-4825
Country	:	US
Telephone Number	:	601-826-0333
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. RONDA TRIVISTA ALDRIDGE
Credential	:	LCSW
Telephone Number	:	601-826-0333

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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Directions to “STEP UP COUNSELING & CONSULTING ” Practice Location

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