Healthcare Provider Details

I. General information

NPI: 1235692534
Provider Name (Legal Business Name): MENDING BROKEN BRIDGES COUNSELING & CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E NORTHSIDE DR STE C
CLINTON MS
39056-3663
US

IV. Provider business mailing address

801 E NORTHSIDE DR STE C
CLINTON MS
39056-3663
US

V. Phone/Fax

Practice location:
  • Phone: 601-473-2299
  • Fax: 601-473-2258
Mailing address:
  • Phone: 601-473-2299
  • Fax: 601-473-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JANICE MOORE HOPKINS
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 601-473-2299