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General NPI Number Information
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NPI Number | 1134945132
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 877 NORTHPARK DR STE 400
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City | RIDGELAND
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State | MS
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Zip | 39157-5220
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Country | US
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Telephone | 601-751-4180
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Fax |
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Provider Business Mailing Address
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Address Line | 231 GRAYHAWK DR
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City | MADISON
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State | MS
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Zip | 39110-4010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. OLIVIA MARTIN
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Credential | LPC
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Telephone | 601-751-4180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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