Healthcare Provider Details

I. General information

NPI: 1215636626
Provider Name (Legal Business Name): SINCLAIR COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 CRANE RIDGE DR STE C
JACKSON MS
39216-4944
US

IV. Provider business mailing address

1925 MELVIN RD
PEARL MS
39208-5619
US

V. Phone/Fax

Practice location:
  • Phone: 601-668-2229
  • Fax:
Mailing address:
  • Phone: 601-668-2229
  • 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: ANNE ELIZABETH SINCLAIR
Title or Position: MANAGER
Credential: LPC
Phone: 601-668-2229