MEDICARE: MANORA WELLNESS GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1386444958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANORA WELLNESS GROUP, LLC

Provider Business Mailing Address
First Line	:	304 BLACKWELL DAIRY RD
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-8406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 BLACKWELL DAIRY RD
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-8406
Country	:	US
Telephone Number	:	205-440-2455
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	ERRICA WILLIAMS
Credential	:
Telephone Number	:	205-229-6160

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/13/2025

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