Healthcare Provider Details

I. General information

NPI: 1710804075
Provider Name (Legal Business Name): HOLISTIC HEALING TO WELLNESS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST
NEWTON MS
39345-2613
US

IV. Provider business mailing address

PO BOX 117
FOREST MS
39074-0117
US

V. Phone/Fax

Practice location:
  • Phone: 601-900-8632
  • Fax:
Mailing address:
  • Phone: 601-900-8632
  • 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: MS. MARQUITA LACHETTE WILSON
Title or Position: OWNER/DIRECTOR
Credential: M.ED., LPC, LGC, NCC
Phone: 601-900-8632