Healthcare Provider Details

I. General information

NPI: 1821921099
Provider Name (Legal Business Name): IGNITE WELLNESS AT REFINING FIRE RANCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 S SKYLINE DRIVE
JASPER AL
35501
US

IV. Provider business mailing address

830 S SKYLINE DR
JASPER AL
35501-7524
US

V. Phone/Fax

Practice location:
  • Phone: 256-856-0603
  • Fax:
Mailing address:
  • Phone: 256-856-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DANYELLE BRAGWELL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 256-856-0603