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General NPI Number Information
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NPI Number | 1770264293
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Entity Type | Organization
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Legal Business Name | CALLOWAY
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 971 FAIRFAX PARK STE C
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2829
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Country | US
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Telephone | 978-435-4045
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PRAIRIE FIELD DR
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City | TUSCALOOSA
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State | AL
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Zip | 35405-9651
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Country | US
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Telephone | 808-218-2200
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST/CEO
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Name | CHARICE CALLOWAY
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Credential | LMFT
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Telephone | 808-218-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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