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General NPI Number Information
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NPI Number | 1881271211
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Entity Type | Organization
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Legal Business Name | REPRESENT WELLNESS LLC
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 611 28TH AVE
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1715
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Country | US
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Telephone | 205-409-8248
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 WATERMELON RD APT B
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City | NORTHPORT
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State | AL
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Zip | 35473-5183
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Country | US
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Telephone | 205-861-4144
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD THERAPIST
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Name | MELANIE SHARONDA BRUNNER
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Credential | LICSW
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Telephone | 205-861-4144
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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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