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General NPI Number Information
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NPI Number | 1194387787
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Entity Type | Organization
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Legal Business Name | LAUREATE' COUNSELING & PERSONAL DEVELOPMENT, LLC
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 510 GEORGE ST STE 214
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City | JACKSON
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State | MS
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Zip | 39202-3029
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Country | US
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Telephone | 769-216-0815
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Fax |
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Provider Business Mailing Address
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Address Line | 510 GEORGE ST STE 214
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City | JACKSON
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State | MS
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Zip | 39202-3029
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Country | US
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Telephone | 769-216-0815
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Fax | 601-510-9785
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOTHERAPIST
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Name | MRS. TISHOUNNA KNOX SULTON
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Credential | LCSW
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Telephone | 769-216-0815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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