Healthcare Provider Details

I. General information

NPI: 1255106480
Provider Name (Legal Business Name): JOURNEYS COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N 40TH AVE
HATTIESBURG MS
39401-6606
US

IV. Provider business mailing address

PO BOX 16805
HATTIESBURG MS
39404-6805
US

V. Phone/Fax

Practice location:
  • Phone: 769-390-7929
  • Fax:
Mailing address:
  • Phone: 769-390-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANICE MOORE
Title or Position: OWNER/CLINICIAN
Credential: LLC
Phone: 769-390-7929