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General NPI Number Information
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NPI Number | 1962273722
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Entity Type | Organization
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Legal Business Name | THE COUNSELOR IN FLIP-FLOPS, LLC
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 6952 DOGWOOD MNR N STE 101
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2091
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Country | US
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Telephone | 662-782-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 4828 ANTEBELLUM LN
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6575
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Country | US
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Telephone | 256-682-9230
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Fax |
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL COUNSELOR
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Name | DR. KATHARINE GRACE JOHNSON
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Credential | PHD, LPC-S, NCC
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Telephone | 256-682-9230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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