Healthcare Provider Details

I. General information

NPI: 1679305650
Provider Name (Legal Business Name): SOWING SEEDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 STONE COVE
CLINTON MS
39056-5020
US

IV. Provider business mailing address

114 STONE COVE
CLINTON MS
39056-5020
US

V. Phone/Fax

Practice location:
  • Phone: 601-572-4268
  • Fax: 601-488-5003
Mailing address:
  • Phone: 601-572-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LURETHA ROENEKA KELLY
Title or Position: OWNER, MANAGER
Credential: LCSW
Phone: 601-572-4268