| Providence Counseling Llc | |
|
214 Benson Rd Gardendale AL 35071-3851 | |
| (205) 903-6719 | |
| Not Available |
| Full Name | Providence Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 214 Benson Rd, Gardendale, Alabama |
| Authorized Official Name and Position | Phillip Terrell Williams (OWNER) |
| Authorized Official Contact | 2059036719 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Counseling Llc 214 Benson Rd Gardendale AL 35071-3851 Ph: (205) 903-6719 | Providence Counseling Llc 214 Benson Rd Gardendale AL 35071-3851 Ph: (205) 903-6719 |
| NPI Number | 1215500665 |
|---|---|
| Provider Enumeration Date | 07/22/2021 |
| Last Update Date | 07/22/2021 |
| Certification Date | 07/22/2021 |
| Medicare PECOS PAC ID | 8123464468 |
|---|---|
| Medicare Enrollment ID | O20240309000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215500665 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Phillip Terrell Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316514904 PECOS PAC ID: 9032555370 Enrollment ID: I20240309000025 |
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