Provider Demographics
NPI:1962273722
Name:THE COUNSELOR IN FLIP-FLOPS, LLC
Entity type:Organization
Organization Name:THE COUNSELOR IN FLIP-FLOPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S, NCC
Authorized Official - Phone:256-682-9230
Mailing Address - Street 1:4828 ANTEBELLUM LN
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6575
Mailing Address - Country:US
Mailing Address - Phone:256-682-9230
Mailing Address - Fax:
Practice Address - Street 1:6952 DOGWOOD MNR N STE 101
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2091
Practice Address - Country:US
Practice Address - Phone:662-782-6652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)