1205598844 NPI number — SYLACAUGA COUNSELING & WELLNESS, LLC

Table of content: (NPI 1205598844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205598844 NPI number — SYLACAUGA COUNSELING & WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYLACAUGA COUNSELING & WELLNESS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205598844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2021
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENDALE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35071-1880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-213-7049
Provider Business Mailing Address Fax Number:
205-278-8755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLACAUGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35150-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-607-2331
Provider Business Practice Location Address Fax Number:
205-278-8755
Provider Enumeration Date:
10/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
LATONIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
205-213-7049

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com