Provider Demographics
NPI:1922622562
Name:WELLNESS COUNSELING & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:WELLNESS COUNSELING & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:769-218-9054
Mailing Address - Street 1:4780 I-55 N
Mailing Address - Street 2:STE. 100-1025
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5583
Mailing Address - Country:US
Mailing Address - Phone:769-218-9054
Mailing Address - Fax:769-333-9157
Practice Address - Street 1:4780 I-55 N
Practice Address - Street 2:STE. 100-1025
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5583
Practice Address - Country:US
Practice Address - Phone:769-218-9054
Practice Address - Fax:769-333-9157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS COUNSELING & CONSULTING SE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-29
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS006931211Medicaid