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General NPI Number Information
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NPI Number | 1073130894
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Entity Type | Organization
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Legal Business Name | LIFECARE WELLNESS
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Dates
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Enumeration Date | 06/27/2020
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Last Update Date | 06/27/2020
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Provider Practice Location Address
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Address Line | 653 HELEN KELLER BLVD
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City | TUSCALOOSA
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State | AL
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Zip | 35404-2983
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Country | US
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Telephone | 205-331-3836
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Fax | 205-293-5515
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Provider Business Mailing Address
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Address Line | 216 2ND ST SW
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City | GORDO
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State | AL
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Zip | 35466-2221
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Country | US
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Telephone | 205-331-3836
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Fax | 205-293-5516
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | COURTNEY BROOKE WILLIAMSON
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Credential |
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Telephone | 205-331-3836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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