Healthcare Provider Details

I. General information

NPI: 1114665213
Provider Name (Legal Business Name): EMBRACE YOUR BEST LIFE COUNSELING AND WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 2ND PL NW
CENTER POINT AL
35215-3406
US

IV. Provider business mailing address

2224 2ND PL NW
CENTER POINT AL
35215-3406
US

V. Phone/Fax

Practice location:
  • Phone: 205-585-2689
  • Fax:
Mailing address:
  • Phone: 205-585-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WOOD DAVIDSON
Title or Position: CLINICAL OPERATIONS
Credential: LMFT
Phone: 205-585-2689