Provider Demographics
NPI:1871183541
Name:THERAPEUTIC LIFE CONCEPTS OF CENTRAL ALABAMA
Entity type:Organization
Organization Name:THERAPEUTIC LIFE CONCEPTS OF CENTRAL ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SANDERS
Authorized Official - Last Name:MCCARY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:334-419-1303
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0115
Mailing Address - Country:US
Mailing Address - Phone:334-872-9060
Mailing Address - Fax:
Practice Address - Street 1:2918 CITIZENS PKWY STE 203
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-3947
Practice Address - Country:US
Practice Address - Phone:334-419-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty