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General NPI Number Information
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NPI Number | 1568227817
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Entity Type | Organization
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Legal Business Name | SHIELDS OF HOPE COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 201 N COLLEGE ST STE 108
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City | BRANDON
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State | MS
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Zip | 39042-4437
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Country | US
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Telephone | 763-241-0545
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1573
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City | BRANDON
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State | MS
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Zip | 39043-1573
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTWYNETTE B SHIELDS
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Credential | LPC-S
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Telephone | 228-563-4670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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