| Vitality Counseling | |
|
208 Key Dr Ste C Madison MS 39110-7378 | |
| (601) 760-2050 | |
| Not Available |
| Full Name | Vitality Counseling |
|---|---|
| Speciality | Counselor |
| Location | 208 Key Dr Ste C, Madison, Mississippi |
| Authorized Official Name and Position | Craig Watson (CEO) |
| Authorized Official Contact | 6017602050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Counseling 1888 Main St Ste C-419 Madison MS 39110-6337 Ph: () - | Vitality Counseling 208 Key Dr Ste C Madison MS 39110-7378 Ph: (601) 760-2050 |
| NPI Number | 1154904035 |
|---|---|
| Provider Enumeration Date | 04/29/2021 |
| Last Update Date | 08/22/2022 |
| Certification Date | 08/22/2022 |
| Medicare PECOS PAC ID | 3577954650 |
|---|---|
| Medicare Enrollment ID | O20211228001788 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154904035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Danielle Pugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639718455 PECOS PAC ID: 4082044136 Enrollment ID: I20210922001037 |
| Provider Name | Erin I Mccurdy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760153035 PECOS PAC ID: 4082003660 Enrollment ID: I20211122000123 |
| Provider Name | Grace Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982311122 PECOS PAC ID: 6901275544 Enrollment ID: I20221203000329 |
| Provider Name | Kimberly Kanary Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265104608 PECOS PAC ID: 4688031396 Enrollment ID: I20230611000120 |
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