Provider Demographics
NPI:1114508330
Name:CAHABA RIVER THERAPY
Entity Type:Organization
Organization Name:CAHABA RIVER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-319-1391
Mailing Address - Street 1:4007 MONTEVALLO RD S
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-3030
Mailing Address - Country:US
Mailing Address - Phone:205-746-7524
Mailing Address - Fax:
Practice Address - Street 1:2828 OLD 280 CT STE 154
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2657
Practice Address - Country:US
Practice Address - Phone:205-319-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health