Healthcare Provider Details

I. General information

NPI: 1609531458
Provider Name (Legal Business Name): DOXA COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 TOWNSHIP AVE STE 303
RIDGELAND MS
39157-8699
US

IV. Provider business mailing address

141 TOWNSHIP AVE STE 303
RIDGELAND MS
39157-8699
US

V. Phone/Fax

Practice location:
  • Phone: 601-228-1121
  • Fax:
Mailing address:
  • Phone: 601-906-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTA P WITHEROW
Title or Position: OWNER
Credential: LPC, LMFT, CST
Phone: 601-906-8066