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General NPI Number Information
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NPI Number | 1508391632
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Entity Type | Organization
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Legal Business Name | WITHOUT WALLS COUNSELING, PC
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 2100 SOUTHBRIDGE PKWY STE 650
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City | BIRMINGHAM
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State | AL
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Zip | 35209-1302
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Country | US
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Telephone | 205-414-7426
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Fax | 877-308-8259
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Provider Business Mailing Address
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Address Line | 2100 SOUTHBRIDGE PKWY STE 650
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City | BIRMINGHAM
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State | AL
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Zip | 35209-1302
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Country | US
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Telephone | 205-414-7426
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Fax | 877-308-8259
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Authorized Official
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Title or Position | THERAPIST/ AUTHORIZED AGENT
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Name | THANDI KENYETTA WELLS
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Credential | ED.S, LPC
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Telephone | 205-919-3974
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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Taxonomy #3
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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 #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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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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