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General NPI Number Information
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NPI Number | 1548869712
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Entity Type | Organization
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Legal Business Name | PENDLETON COUNSELING CENTER
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 403 OLD TOWN CIR
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City | BRANDON
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State | MS
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Zip | 39042-3628
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Country | US
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Telephone | 601-201-4111
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Fax | 601-825-1793
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Provider Business Mailing Address
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Address Line | 403 OLD TOWN CIR
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City | BRANDON
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State | MS
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Zip | 39042-3628
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Country | US
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Telephone | 601-201-4111
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Fax | 601-825-1793
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | DR. LINDA FAYE PENDLETON
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Credential |
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Telephone | 601-201-4111
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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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