Healthcare Provider Details

I. General information

NPI: 1104412725
Provider Name (Legal Business Name): REACHING WHOLENESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 HIGHWAY 17
HELENA AL
35080-3513
US

IV. Provider business mailing address

3674 HELENA RD
HELENA AL
35080-3246
US

V. Phone/Fax

Practice location:
  • Phone: 205-202-0383
  • Fax:
Mailing address:
  • Phone: 205-202-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KARMEL LAURENE MAYO
Title or Position: OWNER
Credential: MA, LPC
Phone: 205-202-0383