Healthcare Provider Details

I. General information

NPI: 1346658796
Provider Name (Legal Business Name): THE WEALTH LOUNGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GLOVER AVE SUITE 3
ENTERPRISE AL
36330-2070
US

IV. Provider business mailing address

557 GLOVER AVE. SUITE 3
ENTERPRISE AL
36330-2070
US

V. Phone/Fax

Practice location:
  • Phone: 334-489-4448
  • Fax: 334-347-2919
Mailing address:
  • Phone: 334-489-4448
  • Fax: 334-347-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1725
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1725
License Number StateAL

VIII. Authorized Official

Name: DR. TABITHA A GRESSARD
Title or Position: CLINICAL PSYCHOLOGIS
Credential: PSY.D.
Phone: 334-489-4448