Healthcare Provider Details

I. General information

NPI: 1013429042
Provider Name (Legal Business Name): MARION COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BRIARWOOD DR STE 510
JACKSON MS
39206-3057
US

IV. Provider business mailing address

PO BOX 13509
JACKSON MS
39236-3509
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-4816
  • Fax: 601-956-4816
Mailing address:
  • Phone: 601-956-4816
  • Fax: 601-956-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID EDWARD MARION
Title or Position: OWNER
Credential: PH.D.
Phone: 601-956-4816