Healthcare Provider Details

I. General information

NPI: 1922873546
Provider Name (Legal Business Name): EMBRACE COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2023
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 POPLAR SPRINGS DR STE B
MERIDIAN MS
39305-1642
US

IV. Provider business mailing address

4905 POPLAR SPRINGS DR STE B
MERIDIAN MS
39305-1642
US

V. Phone/Fax

Practice location:
  • Phone: 601-453-2824
  • Fax: 601-453-2787
Mailing address:
  • Phone: 601-453-2824
  • Fax: 601-453-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUNTER BURNS
Title or Position: OWNER
Credential: MS, LPC, NCC, BC-TMH
Phone: 601-480-8836