Healthcare Provider Details

I. General information

NPI: 1750151064
Provider Name (Legal Business Name): TOTAL LIFE CHANGE COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GURNEE AVE
ANNISTON AL
36201-3731
US

IV. Provider business mailing address

PO BOX 284
JACKSONVILLE AL
36265-0284
US

V. Phone/Fax

Practice location:
  • Phone: 251-308-1919
  • Fax:
Mailing address:
  • Phone: 251-308-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDRA CUNNINGHAM
Title or Position: OWNER
Credential:
Phone: 251-308-1919