Healthcare Provider Details

I. General information

NPI: 1336992130
Provider Name (Legal Business Name): GARDENIA GRACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 DEVEREUX CIR
VESTAVIA AL
35243-2563
US

IV. Provider business mailing address

3025 PIPER WAY
HOOVER AL
35244-3378
US

V. Phone/Fax

Practice location:
  • Phone: 205-319-9152
  • Fax:
Mailing address:
  • Phone: 205-568-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA HENDERSON
Title or Position: OWNER/COUNSELOR
Credential: M.ED., LPC, NCC
Phone: 205-568-0170