Healthcare Provider Details

I. General information

NPI: 1083330955
Provider Name (Legal Business Name): STILLWATERS COUNSELING GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 CHARMANT PL STE 2
RIDGELAND MS
39157-4352
US

IV. Provider business mailing address

197 CHARMANT PL STE 2
RIDGELAND MS
39157-4352
US

V. Phone/Fax

Practice location:
  • Phone: 601-707-5550
  • Fax:
Mailing address:
  • Phone: 601-707-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DENTON HANKINS
Title or Position: MEMBER
Credential: LCSW
Phone: 601-707-5550