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General NPI Number Information
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NPI Number | 1588022412
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Entity Type | Organization
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Legal Business Name | ROCKET CITY COUNSELOR
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Dates
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Enumeration Date | 02/06/2016
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Last Update Date | 02/06/2016
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Provider Practice Location Address
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Address Line | 201 EASTSIDE SQ SUITE 1
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City | HUNTSVILLE
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State | AL
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Zip | 35801-8823
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Country | US
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Telephone | 256-665-6699
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Fax |
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Provider Business Mailing Address
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Address Line | 201 EASTSIDE SQ SUITE 1
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City | HUNTSVILLE
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State | AL
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Zip | 35801-8823
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Country | US
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Telephone | 256-665-6699
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | LEIGH WILLHELM
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Credential | PHD
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Telephone | 256-665-6699
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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 | 2604
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License Number State | AL
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