Provider Demographics
NPI: | 1619357399 |
---|---|
Name: | JOURNEY TO HEALING,LLC |
Entity Type: | Organization |
Organization Name: | JOURNEY TO HEALING,LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/COUNSELOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LISA |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 251-510-0803 |
Mailing Address - Street 1: | 2865 POTTER DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MOBILE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36606-2359 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 251-510-0803 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4254 COTTAGE HILL RD |
Practice Address - Street 2: | |
Practice Address - City: | MOBILE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36609-4240 |
Practice Address - Country: | US |
Practice Address - Phone: | 251-510-0803 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-06-08 |
Last Update Date: | 2015-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 317 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty |