Provider Demographics
NPI:1063049047
Name:MOSAIC COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:MOSAIC COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:GUIDRY-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LICSW
Authorized Official - Phone:228-243-9771
Mailing Address - Street 1:1850 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1375
Mailing Address - Country:US
Mailing Address - Phone:228-243-9771
Mailing Address - Fax:
Practice Address - Street 1:1850 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1375
Practice Address - Country:US
Practice Address - Phone:251-260-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty