| Grey Space Llc | |
|
6001 Old Leeds Rd Irondale AL 35210-4292 | |
| (205) 202-1883 | |
| Not Available |
| Full Name | Grey Space Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 6001 Old Leeds Rd, Irondale, Alabama |
| Authorized Official Name and Position | Sarah Elise Tidwell (OWNER) |
| Authorized Official Contact | 2052021883 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grey Space Llc 429 Green Springs Hwy Ste 161-367 Birmingham AL 35209-4935 Ph: (205) 202-1883 | Grey Space Llc 6001 Old Leeds Rd Irondale AL 35210-4292 Ph: (205) 202-1883 |
| NPI Number | 1205613965 |
|---|---|
| Provider Enumeration Date | 09/14/2023 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205613965 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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