Healthcare Provider Details

I. General information

NPI: 1366307951
Provider Name (Legal Business Name): WAGSTAFF COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 LINDSAY ST
CHATTANOOGA TN
37403-3405
US

IV. Provider business mailing address

610 LINDSAY ST
CHATTANOOGA TN
37403-3405
US

V. Phone/Fax

Practice location:
  • Phone: 205-913-3780
  • Fax:
Mailing address:
  • Phone: 205-913-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAURA WAGSTAFF
Title or Position: CHIEF EXECUTIVE/ SOLE PROPRIETOR
Credential: LPC-MHSP
Phone: 205-582-7810