Healthcare Provider Details

I. General information

NPI: 1417788696
Provider Name (Legal Business Name): WOVEN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 AIRPORT BLVD STE 100
MOBILE AL
36608-3169
US

IV. Provider business mailing address

5901 AIRPORT BLVD STE 100
MOBILE AL
36608-3169
US

V. Phone/Fax

Practice location:
  • Phone: 251-873-0002
  • Fax:
Mailing address:
  • Phone: 251-202-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHELBY BRISTOW
Title or Position: OWNER
Credential: LPC
Phone: 334-790-6130