Provider Demographics
NPI:1356880207
Name:SOUTHERN WELLNESS SERVICES
Entity type:Organization
Organization Name:SOUTHERN WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELYSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:256-284-7080
Mailing Address - Street 1:2620 HOUGH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1747
Mailing Address - Country:US
Mailing Address - Phone:256-284-7080
Mailing Address - Fax:
Practice Address - Street 1:2620 HOUGH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1747
Practice Address - Country:US
Practice Address - Phone:256-284-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health