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General NPI Number Information
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NPI Number | 1174382691
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Entity Type | Organization
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Legal Business Name | FOUR WINDS COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 6814 CRUMPLER BLVD STE 201A
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1995
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Country | US
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Telephone | 860-304-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 6814 CRUMPLER BLVD STE 201A
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1995
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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 | ALLISON ROGERS
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Credential | LCSW
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Telephone | 860-304-4773
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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