Healthcare Provider Details

I. General information

NPI: 1174382691
Provider Name (Legal Business Name): FOUR WINDS COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 04/23/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6814 CRUMPLER BLVD STE 201A
OLIVE BRANCH MS
38654-1995
US

IV. Provider business mailing address

6814 CRUMPLER BLVD STE 201A
OLIVE BRANCH MS
38654-1995
US

V. Phone/Fax

Practice location:
  • Phone: 860-304-4773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALLISON ROGERS
Title or Position: OWNER
Credential: LCSW
Phone: 860-304-4773