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General NPI Number Information
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NPI Number | 1366202046
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Entity Type | Organization
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Legal Business Name | MENDING HEARTS COUNSELING SERVICES OF CENTRAL ALABAMA, LLC
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 310 COOSA ST E
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City | TALLADEGA
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State | AL
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Zip | 35160-2276
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Country | US
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Telephone | 256-493-5783
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1233
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City | TALLADEGA
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State | AL
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Zip | 35161-1233
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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 | ADMINISTRATOR
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Name | STEPHANIE DATES
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Credential | LICSW
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Telephone | 256-493-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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