Healthcare Provider Details

I. General information

NPI: 1689425373
Provider Name (Legal Business Name): TREE OF LIFE HEALING AND RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 RINGOLD ST
FLOMATON AL
36441-5498
US

IV. Provider business mailing address

PO BOX 823
FLOMATON AL
36441-0823
US

V. Phone/Fax

Practice location:
  • Phone: 251-292-4143
  • Fax: 251-901-2953
Mailing address:
  • Phone: 251-292-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY CLAYTON ROWELL
Title or Position: OWNER
Credential: LICSW
Phone: 251-254-3350