Provider Demographics
NPI:1588022412
Name:ROCKET CITY COUNSELOR
Entity Type:Organization
Organization Name:ROCKET CITY COUNSELOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLHELM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:256-665-6699
Mailing Address - Street 1:201 EASTSIDE SQ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-8823
Mailing Address - Country:US
Mailing Address - Phone:256-665-6699
Mailing Address - Fax:
Practice Address - Street 1:201 EASTSIDE SQ
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-8823
Practice Address - Country:US
Practice Address - Phone:256-665-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2604101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty