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General NPI Number Information
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NPI Number | 1043878788
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Entity Type | Organization
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Legal Business Name | MADE WHOLE COUNSELING, LLC
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 9466 GREENWELL SPRINGS RD
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City | BATON ROUGE
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State | LA
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Zip | 70814-2911
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Country | US
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Telephone | 302-229-4803
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Fax |
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Provider Business Mailing Address
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Address Line | 9826 BUNTING DR
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City | BATON ROUGE
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State | LA
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Zip | 70809-4645
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Country | US
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Telephone | 302-229-4803
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIONNE SMITH
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Credential | LPC
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Telephone | 302-229-4803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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