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General NPI Number Information
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NPI Number | 1588246128
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Entity Type | Organization
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Legal Business Name | STORK MENTALHEALTH & WELLNESS , LLC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 317 E CAPITOL ST STE 200317
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City | JACKSON
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State | MS
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Zip | 39201-3405
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Country | US
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Telephone | 601-844-7696
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Fax | 601-861-4940
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Provider Business Mailing Address
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Address Line | PO BOX 1424
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City | RIDGELAND
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State | MS
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Zip | 39158-1424
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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 | BUSINESS OWNER
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Name | DR. RANARDA WRIGHT
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Credential | LPC, LPC-S, BCTMH
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Telephone | 601-844-7696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 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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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #5
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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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