| Willow Grace Wellness Center Llc | |
|
2028 Kentucky Ave Ste 101&103 Vestavia Hills AL 35216-1946 | |
| (205) 613-0764 | |
| Not Available |
| Full Name | Willow Grace Wellness Center Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2028 Kentucky Ave Ste 101&103, Vestavia Hills, Alabama |
| Authorized Official Name and Position | Tangie Martin Macon (THERAPITST) |
| Authorized Official Contact | 2056130764 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Grace Wellness Center Llc 2028 Kentucky Ave Ste 101&103 Vestavia Hills AL 35216-1946 Ph: (205) 613-0764 | Willow Grace Wellness Center Llc 2028 Kentucky Ave Ste 101&103 Vestavia Hills AL 35216-1946 Ph: (205) 613-0764 |
| NPI Number | 1467020891 |
|---|---|
| Provider Enumeration Date | 06/13/2021 |
| Last Update Date | 06/13/2021 |
| Certification Date | 06/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467020891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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