Organization
SPIRIT OF SERVICE COUNSELING & WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELIZABETH STATUM LPC-MHSP (OWNER/MEMBER)
(901) 550-7867
Entity
Organization
Contact information
Practice address
3568 KEARNEY AVE, MEMPHIS, TN 38111-5743
(901) 550-7867
(901) 529-7139
Mailing address
3568 KEARNEY AVE, MEMPHIS, TN 38111-5743
(901) 550-7867
(901) 529-7139
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
LPC0000002198
TN
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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