Provider Demographics
NPI:1306362405
Name:NEW LEAF COUNSELING, INC
Entity Type:Organization
Organization Name:NEW LEAF COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-483-1086
Mailing Address - Street 1:7075 GOLDEN OAKS LOOP W STE 8
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9011
Mailing Address - Country:US
Mailing Address - Phone:901-483-1086
Mailing Address - Fax:
Practice Address - Street 1:7075 GOLDEN OAKS LOOP W STE 8
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9011
Practice Address - Country:US
Practice Address - Phone:901-483-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty