Provider Demographics
NPI:1609249366
Name:PROGRESSIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERNETTA
Authorized Official - Middle Name:LESIA
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-624-1524
Mailing Address - Street 1:4795 MCWILLIE DR STE 215
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5628
Mailing Address - Country:US
Mailing Address - Phone:601-624-1524
Mailing Address - Fax:
Practice Address - Street 1:4795 MCWILLIE DR STE 215
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5628
Practice Address - Country:US
Practice Address - Phone:601-624-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1825251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health