Healthcare Provider Details

I. General information

NPI: 1619545621
Provider Name (Legal Business Name): HEALING MINDS COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HIGHWAY 80 E
CLINTON MS
39056-4717
US

IV. Provider business mailing address

315 HIGHWAY 80 E
CLINTON MS
39056-4717
US

V. Phone/Fax

Practice location:
  • Phone: 601-488-4852
  • Fax: 601-488-4091
Mailing address:
  • Phone: 601-488-4852
  • Fax: 601-488-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LASHUNDRA CLARK
Title or Position: OWNER/CEO
Credential: LPC
Phone: 601-488-4852