MEDICARE: ESSENTIAL CONNECTIONS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1285117945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL CONNECTIONS COUNSELING LLC

Provider Business Mailing Address
First Line	:	3825 LORNA RD STE 240
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-3003
Country	:	US
Telephone Number	:	205-985-4939
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 LORNA RD STE 240
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-3003
Country	:	US
Telephone Number	:	205-985-4939
Fax Number	:	205-985-4431

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KRISTEN M. WOODS
Credential	:
Telephone Number	:	205-985-4939

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	02/25/2019

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