Provider Demographics
NPI:1346658796
Name:THE WEALTH LOUNGE
Entity Type:Organization
Organization Name:THE WEALTH LOUNGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRESSARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:334-489-4448
Mailing Address - Street 1:557 GLOVER AVE.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2070
Mailing Address - Country:US
Mailing Address - Phone:334-489-4448
Mailing Address - Fax:334-347-2919
Practice Address - Street 1:557 GLOVER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2070
Practice Address - Country:US
Practice Address - Phone:334-489-4448
Practice Address - Fax:334-347-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1725103TC0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty