Provider Demographics
NPI:1659145977
Name:PEACE BE STILL THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PEACE BE STILL THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:205-446-0294
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:BAILEYTON
Mailing Address - State:AL
Mailing Address - Zip Code:35019-0143
Mailing Address - Country:US
Mailing Address - Phone:205-446-0294
Mailing Address - Fax:
Practice Address - Street 1:10865 US HIGHWAY 278 E STE A
Practice Address - Street 2:
Practice Address - City:HOLLY POND
Practice Address - State:AL
Practice Address - Zip Code:35083-6884
Practice Address - Country:US
Practice Address - Phone:205-446-0294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty