MEDICARE: ISLANDS COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1148	MS

General Provider Information

NPI Number	:	1497191639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLANDS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2953 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4305
Country	:	US
Telephone Number	:	228-324-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 HOLCOMB BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3943
Country	:	US
Telephone Number	:	228-324-3244
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICENSED COUNSELOR/SUPERVISOR
Name	:	MARCIA CRETIN BARKSDALE
Credential	:	LPC, NCC
Telephone Number	:	228-324-3244

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/15/2013

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