Healthcare Provider Details

I. General information

NPI: 1649833625
Provider Name (Legal Business Name): WHOLEHEARTED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 RIVERCHASE PKWY E STE 103
HOOVER AL
35244-2815
US

IV. Provider business mailing address

913 5TH CT NW
ALABASTER AL
35007-9073
US

V. Phone/Fax

Practice location:
  • Phone: 205-837-4979
  • Fax:
Mailing address:
  • Phone: 205-837-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA HAWBAKER
Title or Position: OWNER
Credential: LPC
Phone: 205-837-4979