=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861994998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND IN MOMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2018
-----------------------------------------------------
Last Update Date | 09/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 BAGBY DR STE 355
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-538-3768
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 BAGBY DR STE 355
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-538-3768
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | SONJA SPILLER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 205-305-6036
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 3519
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------