Healthcare Provider Details

I. General information

NPI: 1235046913
Provider Name (Legal Business Name): WILLOW BEHAVIORAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 WAVERLY PKWY
OPELIKA AL
36801-3311
US

IV. Provider business mailing address

2900 WAVERLY PKWY
OPELIKA AL
36801-3311
US

V. Phone/Fax

Practice location:
  • Phone: 334-442-9693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LASHUNDRA VINES
Title or Position: OWNER
Credential: LPC, LPCC, LCMHC
Phone: 678-778-9866