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General NPI Number Information
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NPI Number | 1326866120
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Entity Type | Organization
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Legal Business Name | EBULLIENCE COUNSELING
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 501 AVALON WAY STE D
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City | BRANDON
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State | MS
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Zip | 39047-7500
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Country | US
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Telephone | 601-874-3340
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Fax | 601-494-3241
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Provider Business Mailing Address
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Address Line | PO BOX 68375
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City | JACKSON
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State | MS
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Zip | 39286-8375
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Country | US
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Telephone | 601-874-3340
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Fax | 601-494-3340
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Authorized Official
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Title or Position | OWNER, OPERATOR
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Name | MISS ERICA ASHLEY BRUMFIELD
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Credential | LPC
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Telephone | 601-874-3340
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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