Healthcare Provider Details

I. General information

NPI: 1134038839
Provider Name (Legal Business Name): THE BROAD PLACE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 WILDOAK DR
ANNISTON AL
36206-1354
US

IV. Provider business mailing address

PO BOX 4023
ANNISTON AL
36204-4023
US

V. Phone/Fax

Practice location:
  • Phone: 256-365-7131
  • Fax:
Mailing address:
  • Phone: 256-365-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ROD CAMPBELL
Title or Position: OWNER
Credential:
Phone: 256-365-7131