Provider Demographics
NPI:1902236334
Name:ALABAMA WELLNESS AND RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:ALABAMA WELLNESS AND RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUDENMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ALC, ICADC, SAP
Authorized Official - Phone:205-306-1164
Mailing Address - Street 1:4898 VALLEYDALE RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4654
Mailing Address - Country:US
Mailing Address - Phone:205-306-1164
Mailing Address - Fax:
Practice Address - Street 1:4898 VALLEYDALE RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4654
Practice Address - Country:US
Practice Address - Phone:205-306-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2055A101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty