Healthcare Provider Details

I. General information

NPI: 1396344347
Provider Name (Legal Business Name): CHILD'S PLAY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 LORNA RD STE 220
HOOVER AL
35216-4518
US

IV. Provider business mailing address

3057 LORNA RD STE 220
HOOVER AL
35216-4518
US

V. Phone/Fax

Practice location:
  • Phone: 404-974-9919
  • Fax:
Mailing address:
  • Phone: 404-974-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAYLOR DAVIDSON
Title or Position: CEO
Credential:
Phone: 404-974-9919