Provider Demographics
NPI:1366202046
Name:MENDING HEARTS COUNSELING SERVICES OF CENTRAL ALABAMA, LLC
Entity type:Organization
Organization Name:MENDING HEARTS COUNSELING SERVICES OF CENTRAL ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DATES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-493-5783
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35161-1233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 COOSA ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2276
Practice Address - Country:US
Practice Address - Phone:256-493-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty