Healthcare Provider Details

I. General information

NPI: 1568378024
Provider Name (Legal Business Name): THE WELLNESS ROOM COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BROADWAY DR STE 10
HATTIESBURG MS
39401-5074
US

IV. Provider business mailing address

87 WOODVILLE TRCE
HATTIESBURG MS
39402-8347
US

V. Phone/Fax

Practice location:
  • Phone: 601-255-7751
  • Fax:
Mailing address:
  • Phone: 601-255-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES EDWARD LAWRENCE
Title or Position: OWNER
Credential: LCSW
Phone: 601-255-7751