Provider Demographics
NPI:1770264293
Name:CALLOWAY
Entity type:Organization
Organization Name:CALLOWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-218-2200
Mailing Address - Street 1:300 PRAIRIE FIELD DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-9651
Mailing Address - Country:US
Mailing Address - Phone:808-218-2200
Mailing Address - Fax:
Practice Address - Street 1:971 FAIRFAX PARK STE C
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2829
Practice Address - Country:US
Practice Address - Phone:978-435-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)