Healthcare Provider Details

I. General information

NPI: 1659148369
Provider Name (Legal Business Name): FULL CIRCLE COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BEAVER RUN CT
RIDGELAND MS
39157-2131
US

IV. Provider business mailing address

102 BEAVER RUN CT
RIDGELAND MS
39157-2131
US

V. Phone/Fax

Practice location:
  • Phone: 770-634-6686
  • Fax:
Mailing address:
  • Phone: 770-634-6686
  • 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: DR. AMIRAH NELSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: PH.D. LPC
Phone: 770-634-6686