Healthcare Provider Details

I. General information

NPI: 1114508330
Provider Name (Legal Business Name): CAHABA RIVER THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 OLD 280 CT STE 154
VESTAVIA AL
35243-2657
US

IV. Provider business mailing address

4007 MONTEVALLO RD S
MOUNTAIN BRK AL
35213-3030
US

V. Phone/Fax

Practice location:
  • Phone: 205-319-1391
  • Fax:
Mailing address:
  • Phone: 205-746-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE CLAYTON PRINCE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 205-319-1391