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General NPI Number Information
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NPI Number | 1942830757
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Entity Type | Organization
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Legal Business Name | TRINITY WELLNESS COUNSELING LLC.
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 902 C M FAGAN DR STE G
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City | HAMMOND
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State | LA
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Zip | 70403-6043
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Country | US
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Telephone | 985-474-4958
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Fax | 985-318-7617
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Provider Business Mailing Address
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Address Line | 61540 BENNETT RD
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City | AMITE
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State | LA
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Zip | 70422
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Country | US
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Telephone | 985-474-4958
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Fax |
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Authorized Official
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Title or Position | OWNER/ AUTHORIZED AGENT
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Name | KERMINDRA L MABERRY
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Credential | LCSW
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Telephone | 985-474-4958
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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