Healthcare Provider Details

I. General information

NPI: 1740193168
Provider Name (Legal Business Name): ROSE THERAPY COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 E TENNESSEE ST STE B
FLORENCE AL
35630-5806
US

IV. Provider business mailing address

618 E TENNESSEE ST STE B
FLORENCE AL
35630-5806
US

V. Phone/Fax

Practice location:
  • Phone: 205-362-1719
  • Fax:
Mailing address:
  • Phone: 205-362-1719
  • 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: BROOKE ELIZABETH ROSE
Title or Position: FOUNDER/PSYCHOTHERAPIST
Credential: LICSW-S
Phone: 205-362-1719