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General NPI Number Information
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NPI Number | 1689425373
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE HEALING AND RECOVERY LLC
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 2118 RINGOLD ST
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City | FLOMATON
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State | AL
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Zip | 36441-5498
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Country | US
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Telephone | 251-292-4143
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Fax | 251-901-2953
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Provider Business Mailing Address
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Address Line | PO BOX 823
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City | FLOMATON
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State | AL
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Zip | 36441-0823
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Country | US
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Telephone | 251-292-4143
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY CLAYTON ROWELL
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Credential | LICSW
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Telephone | 251-254-3350
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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