Healthcare Provider Details

I. General information

NPI: 1154926459
Provider Name (Legal Business Name): EXODUS COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 W VALLEY AVE STE 310
BIRMINGHAM AL
35209-3619
US

IV. Provider business mailing address

PO BOX 13966
BIRMINGHAM AL
35202-3941
US

V. Phone/Fax

Practice location:
  • Phone: 205-683-5590
  • Fax: 800-915-5957
Mailing address:
  • Phone: 205-683-5590
  • Fax: 800-915-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LATONYA MELTON
Title or Position: OWNER
Credential: LPC
Phone: 205-683-5590