Provider Demographics
NPI:1154926459
Name:EXODUS COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:EXODUS COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-683-5590
Mailing Address - Street 1:PO BOX 13966
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-3941
Mailing Address - Country:US
Mailing Address - Phone:205-683-5590
Mailing Address - Fax:800-915-5957
Practice Address - Street 1:181 W VALLEY AVE STE 141
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3691
Practice Address - Country:US
Practice Address - Phone:205-683-5590
Practice Address - Fax:800-915-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALNAOtherN/A