MEDICARE: SYLACAUGA COUNSELING & WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205598844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLACAUGA COUNSELING & WELLNESS, LLC

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

Provider Business Practice Location Address
First Line	:	13 WESTERN AVE
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2939
Country	:	US
Telephone Number	:	205-607-2331
Fax Number	:	205-278-8755

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	LATONIA SIMS
Credential	:	LICSW, PIP
Telephone Number	:	205-213-7049

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	10/15/2021

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