Provider Demographics
NPI:1750677100
Name:TOLES, ANNE ELAINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:ELAINE
Last Name:TOLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2654
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-2654
Mailing Address - Country:US
Mailing Address - Phone:601-941-7171
Mailing Address - Fax:
Practice Address - Street 1:930 EBENEZER BLVD STE D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6079
Practice Address - Country:US
Practice Address - Phone:601-941-7171
Practice Address - Fax:601-790-7909
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional