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General NPI Number Information
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NPI Number | 1124806344
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Entity Type | Organization
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Legal Business Name | WELLS OF LIFE COUNSELING LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 10536 AUTO MALL PKWY STE B
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City | DIBERVILLE
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State | MS
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Zip | 39540-3742
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Country | US
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Telephone | 985-260-1914
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | PEARL RIVER
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State | LA
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Zip | 70452-0267
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Country | US
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Telephone | 504-329-2859
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GRETCHEN P. PETRIE
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Credential | LPC
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Telephone | 985-260-1914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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