Healthcare Provider Details

I. General information

NPI: 1942830757
Provider Name (Legal Business Name): TRINITY WELLNESS COUNSELING LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 C M FAGAN DR STE G
HAMMOND LA
70403-6043
US

IV. Provider business mailing address

61540 BENNETT RD
AMITE LA
70422
US

V. Phone/Fax

Practice location:
  • Phone: 985-474-4958
  • Fax: 985-318-7617
Mailing address:
  • Phone: 985-474-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KERMINDRA L MABERRY
Title or Position: OWNER/ AUTHORIZED AGENT
Credential: LCSW
Phone: 985-474-4958