=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821733445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INCEPTIONCARE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2022
-----------------------------------------------------
Last Update Date | 04/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2824 7TH ST
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-292-8772
-----------------------------------------------------
Fax | 205-409-8957
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 RICE VALLEY RD NE
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-292-8772
-----------------------------------------------------
Fax | 205-409-8957
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. ARIELA H AARON
-----------------------------------------------------
Credential | ED.S; LPC
-----------------------------------------------------
Telephone | 205-292-8882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------