Healthcare Provider Details

I. General information

NPI: 1700629755
Provider Name (Legal Business Name): TRANSFORMATIVE GRIEF COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CREEKVIEW CIRCLE TELEHEALTH ONLY
GARDENDALE AL
35071-3659
US

IV. Provider business mailing address

PO BOX 235
GARDENDALE AL
35071-0235
US

V. Phone/Fax

Practice location:
  • Phone: 205-693-9039
  • Fax: 205-631-2566
Mailing address:
  • Phone: 205-693-9039
  • Fax: 205-631-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VEVELYN PETERSON WILSON
Title or Position: OWNER
Credential: LICSW
Phone: 205-693-9039