# WILLOW GRACE WELLNESS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Grace Wellness Center LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467020891
- **Authorized official:** MRS. TANGIE MARTIN MACON MSW, LICSW, PIP (THERAPITST)
- **Authorized official phone:** (205) 613-0764

## Contact information

- **Practice address:** 2028 KENTUCKY AVE STE 101&103, VESTAVIA HILLS, AL 35216-1946
- **Practice address phone:** (205) 613-0764
- **Mailing address:** 2028 KENTUCKY AVE STE 101&103, VESTAVIA HILLS, AL 35216-1946
- **Mailing address phone:** (205) 613-0764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2021
- **Last updated:** 06/13/2021