MEDICARE: AFFIRMING CARE COUNSELING AND 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467041996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFIRMING CARE COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	464 BLACK RAVENS CT
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-6455
Country	:	US
Telephone Number	:	706-442-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	7806 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1333
Country	:	US
Telephone Number	:	334-413-4055
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	KIMYATTA GREATHOUSE FAILS
Credential	:
Telephone Number	:	334-413-4055

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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