=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881976488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN CHANGES COUNSELING & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2011
-----------------------------------------------------
Last Update Date | 09/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 E LAMPKIN ST
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39759-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-338-1880
-----------------------------------------------------
Fax | 662-338-1880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 E LAMPKIN ST
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39759-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-338-1880
-----------------------------------------------------
Fax | 662-338-1880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE & CLINICAL DIRECTOR
-----------------------------------------------------
Name | MS. WENDIE W WOODS
-----------------------------------------------------
Credential | LPC, RPT-S
-----------------------------------------------------
Telephone | 662-338-1880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 696
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------