Healthcare Provider Details

I. General information

NPI: 1063336295
Provider Name (Legal Business Name): CENTER FOR COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 COMMERCE ST STE D
LAUREL MS
39440-3954
US

IV. Provider business mailing address

525 COMMERCE ST STE D
LAUREL MS
39440-3954
US

V. Phone/Fax

Practice location:
  • Phone: 602-320-9053
  • Fax:
Mailing address:
  • Phone: 602-320-9053
  • Fax:

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: DR. WENDY BROWN CELORIA
Title or Position: SUPERVISOR/OWNER
Credential: PH.D
Phone: 602-320-9053