Provider Demographics
NPI:1679049399
Name:CAHABA THERAPY & WELLNESS
Entity Type:Organization
Organization Name:CAHABA THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, PIP
Authorized Official - Phone:205-649-0344
Mailing Address - Street 1:4741 SYLVANER LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2412
Mailing Address - Country:US
Mailing Address - Phone:205-649-0344
Mailing Address - Fax:
Practice Address - Street 1:2100 SOUTHBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-1302
Practice Address - Country:US
Practice Address - Phone:205-649-0344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)