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General NPI Number Information
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NPI Number | 1831573153
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Entity Type | Organization
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Legal Business Name | CREATIVE WELLNESS INSTITUTE
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1116 23RD ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2410
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Country | US
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Telephone | 205-933-5422
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 23RD ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2410
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Country | US
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Telephone | 205-933-5422
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | EVE LAXER
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Credential | LCSW
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Telephone | 205-933-5422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1107C
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License Number State | AL
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