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General NPI Number Information
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NPI Number | 1881244333
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Entity Type | Organization
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Legal Business Name | THE BUTTERFLY EFFECT THERAPY & WELLNESS
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 7753 1ST AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35206-4312
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Country | US
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Telephone | 205-774-8442
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Fax | 205-278-8769
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Provider Business Mailing Address
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Address Line | 304 27TH AVE NW
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City | CENTER POINT
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State | AL
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Zip | 35215-2424
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Country | US
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Telephone | 205-774-8442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA BONCIA BLACKLEDGE BURR
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Credential | LICSW
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Telephone | 205-774-8442
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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 |
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License Number State |
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