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General NPI Number Information
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NPI Number | 1043029572
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Entity Type | Organization
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Legal Business Name | METIME MOGUL LLC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1375 FEDERAL DR
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City | MONTGOMERY
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State | AL
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Zip | 36107-1121
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Country | US
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Telephone | 334-440-6437
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Fax |
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Provider Business Mailing Address
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Address Line | 443 BURTON AVE
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City | MONTGOMERY
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State | AL
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Zip | 36104-5135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUNKEISSA CANTRELL
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Credential |
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Telephone | 334-440-6437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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