Healthcare Provider Details

I. General information

NPI: 1285512194
Provider Name (Legal Business Name): CIRCLE OF LIFE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 COUNTY ROAD 367
FLORENCE AL
35634-2116
US

IV. Provider business mailing address

341 COUNTY ROAD 367
FLORENCE AL
35634-2116
US

V. Phone/Fax

Practice location:
  • Phone: 256-740-7401
  • Fax:
Mailing address:
  • Phone: 256-740-7401
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARGIE JOHNSON
Title or Position: OWNER
Credential: LICSW
Phone: 256-740-7401