Provider Demographics
NPI:1124806344
Name:WELLS OF LIFE COUNSELING LLC
Entity type:Organization
Organization Name:WELLS OF LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:985-260-1914
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-0267
Mailing Address - Country:US
Mailing Address - Phone:504-329-2859
Mailing Address - Fax:
Practice Address - Street 1:10536 AUTO MALL PKWY STE B
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-3742
Practice Address - Country:US
Practice Address - Phone:985-260-1914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty