Healthcare Provider Details

I. General information

NPI: 1922933779
Provider Name (Legal Business Name): EASTERN SHORE MENTAL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 ASTER CIR
FAIRHOPE AL
36532-7492
US

IV. Provider business mailing address

264 ASTER CIR
FAIRHOPE AL
36532-7492
US

V. Phone/Fax

Practice location:
  • Phone: 334-372-4406
  • Fax:
Mailing address:
  • Phone: 334-372-4406
  • 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: HEATHER S HARTWELL
Title or Position: OWNER
Credential: PH.D.
Phone: 334-372-4406