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General NPI Number Information
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NPI Number | 1255401618
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Entity Type | Organization
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Legal Business Name | THE COUNSELOR'S CABIN PLLC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2100 9TH ST STE 306
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City | MERIDIAN
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State | MS
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Zip | 39301-5005
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Country | US
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Telephone | 601-482-2246
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Fax | 601-692-2246
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Provider Business Mailing Address
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Address Line | 2100 9TH ST STE 306
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City | MERIDIAN
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State | MS
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Zip | 39301-5005
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Country | US
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Telephone | 601-482-2246
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Fax | 601-692-2246
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SACKY HORNE HOLDINESS
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Credential | PHD
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Telephone | 601-482-2246
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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 | 0899
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License Number State | MS
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