Provider Demographics
NPI:1104412725
Name:REACHING WHOLENESS, LLC
Entity type:Organization
Organization Name:REACHING WHOLENESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARMEL
Authorized Official - Middle Name:LAURENE
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:205-202-0383
Mailing Address - Street 1:3674 HELENA RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-3246
Mailing Address - Country:US
Mailing Address - Phone:205-202-0383
Mailing Address - Fax:
Practice Address - Street 1:5140 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-3513
Practice Address - Country:US
Practice Address - Phone:205-202-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1528627171OtherNPI- INDIVIDUAL
AL4336OtherLPC