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General NPI Number Information
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NPI Number | 1306362405
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Entity Type | Organization
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Legal Business Name | NEW LEAF COUNSELING, INC
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 7075 GOLDEN OAKS LOOP W STE 8
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9011
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Country | US
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Telephone | 901-483-1086
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Fax |
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Provider Business Mailing Address
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Address Line | 7075 GOLDEN OAKS LOOP W STE 8
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9011
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Country | US
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Telephone | 901-483-1086
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | KATIE CHRISTIDES
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Credential | LCSW
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Telephone | 901-483-1086
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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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