Healthcare Provider Details

I. General information

NPI: 1982190740
Provider Name (Legal Business Name): LIFE ANCHORS CHILD & ADOLESCENT COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 GRELOT RD
MOBILE AL
36609-3602
US

IV. Provider business mailing address

6300 GRELOT ROAD STE G #51133
MOBILE AL
36609
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-5666
  • Fax:
Mailing address:
  • Phone: 251-295-1750
  • 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: PATRICK SPOMER
Title or Position: OWNER
Credential:
Phone: 251-295-1750