Provider Demographics
NPI:1356583322
Name:CELORIA, WENDY B (MA, LPC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:CELORIA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LOWERY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-8884
Mailing Address - Country:US
Mailing Address - Phone:602-320-9053
Mailing Address - Fax:
Practice Address - Street 1:5 LOWERY CREEK RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-8884
Practice Address - Country:US
Practice Address - Phone:602-320-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional