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General NPI Number Information
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NPI Number | 1346658796
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Entity Type | Organization
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Legal Business Name | THE WEALTH LOUNGE
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 557 GLOVER AVE SUITE 3
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City | ENTERPRISE
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State | AL
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Zip | 36330-2070
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Country | US
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Telephone | 334-489-4448
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Fax | 334-347-2919
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Provider Business Mailing Address
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Address Line | 557 GLOVER AVE. SUITE 3
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City | ENTERPRISE
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State | AL
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Zip | 36330-2070
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Country | US
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Telephone | 334-489-4448
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Fax | 334-347-2919
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIS
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Name | DR. TABITHA A GRESSARD
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Credential | PSY.D.
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Telephone | 334-489-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1725
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1725
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License Number State | AL
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