Provider Demographics
NPI:1265024863
Name:MENTAL WELLNESS CLINICAL COUNSELING AND SERVICES
Entity Type:Organization
Organization Name:MENTAL WELLNESS CLINICAL COUNSELING AND SERVICES
Other - Org Name:MENTAL WELLNESS CLINICAL COUNSELING AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-469-7007
Mailing Address - Street 1:5820 FARMWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8005
Mailing Address - Country:US
Mailing Address - Phone:252-469-7007
Mailing Address - Fax:252-371-1646
Practice Address - Street 1:127 GOLDSBORO ST S
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4903
Practice Address - Country:US
Practice Address - Phone:252-469-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health