Healthcare Provider Details

I. General information

NPI: 1659145977
Provider Name (Legal Business Name): PEACE BE STILL THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BROOKLYN RD STE C
HOLLY POND AL
35083-6487
US

IV. Provider business mailing address

PO BOX 143
BAILEYTON AL
35019-0143
US

V. Phone/Fax

Practice location:
  • Phone: 205-446-0294
  • Fax:
Mailing address:
  • Phone: 205-446-0294
  • 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: MRS. SHAWN M CARROLL
Title or Position: OWNER
Credential: LPC-S
Phone: 205-446-0294