Provider Demographics
NPI:1093413718
Name:SANAVITATHERAPY
Entity Type:Organization
Organization Name:SANAVITATHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:FALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS
Authorized Official - Phone:256-590-2988
Mailing Address - Street 1:2312 MOUNTAIN RUN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1930
Mailing Address - Country:US
Mailing Address - Phone:205-775-7757
Mailing Address - Fax:
Practice Address - Street 1:2344 VALLEYDALE RD STE B
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2074
Practice Address - Country:US
Practice Address - Phone:205-775-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-87016OtherBCBS