Provider Demographics
NPI:1235692534
Name:MENDING BROKEN BRIDGES COUNSELING & CONSULTATION, LLC
Entity Type:Organization
Organization Name:MENDING BROKEN BRIDGES COUNSELING & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-473-2299
Mailing Address - Street 1:801 E NORTHSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3663
Mailing Address - Country:US
Mailing Address - Phone:601-473-2299
Mailing Address - Fax:601-473-2258
Practice Address - Street 1:801 E NORTHSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3663
Practice Address - Country:US
Practice Address - Phone:601-473-2299
Practice Address - Fax:601-473-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty