Organization
BROKEN BUT YET HEALED THERAPEUTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LASHEENA DAVIS M.S., ALC (OWNER)
(209) 752-0290
Entity
Organization
Contact information
Practice address
7 E 13TH ST, SUITE 227, ANNISTON, AL 36201-4601
(334) 392-0105
Mailing address
PO BOX 19862, BIRMINGHAM, AL 35219-0862
(334) 392-0105
(888) 892-5809
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C2251A
AL
101YM0800X
Mental Health Counselor
C2251A
AL
103K00000X
Behavior Analyst
C2251A
AL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Enumeration date
03/19/2015
Last updated
04/21/2015
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