Healthcare Provider Details

I. General information

NPI: 1780120055
Provider Name (Legal Business Name): LIFE STEPS COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 RIDGEWOOD RD SUITE B
JACKSON MS
39216-4922
US

IV. Provider business mailing address

2637 RIDGEWOOD ROAD SUITE B
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-201-3822
  • Fax:
Mailing address:
  • Phone: 601-201-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC6371
License Number StateMS

VIII. Authorized Official

Name: ANGIE REDDING
Title or Position: THERAPIST
Credential: LCSW
Phone: 601-201-3822