Provider Demographics
NPI:1003432626
Name:POSITIVE INNERGY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:POSITIVE INNERGY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OYA
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-917-0271
Mailing Address - Street 1:PO BOX 4523
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39304-4523
Mailing Address - Country:US
Mailing Address - Phone:601-917-0271
Mailing Address - Fax:
Practice Address - Street 1:6562 KING RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-8364
Practice Address - Country:US
Practice Address - Phone:601-917-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)