Healthcare Provider Details

I. General information

NPI: 1003476714
Provider Name (Legal Business Name): GROWING IN THE DARK COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 3RD AVE SW
REFORM AL
35481
US

IV. Provider business mailing address

904 7TH STREET ALT NW
REFORM AL
35481
US

V. Phone/Fax

Practice location:
  • Phone: 205-219-2293
  • Fax:
Mailing address:
  • Phone: 205-219-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER GOSA
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 205-219-2293