Provider Demographics
NPI:1992268270
Name:CONNECTING THE DOTS THERAPY, LLC
Entity type:Organization
Organization Name:CONNECTING THE DOTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:769-524-4305
Mailing Address - Street 1:PO BOX 54475
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39288-4475
Mailing Address - Country:US
Mailing Address - Phone:769-524-4305
Mailing Address - Fax:769-524-4321
Practice Address - Street 1:3823 HIGHWAY 80 E STE 600
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4278
Practice Address - Country:US
Practice Address - Phone:769-524-4305
Practice Address - Fax:769-524-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07504511Medicaid