Organization
WILLOW GRACE WELLNESS CENTER LLC
Active
Other names
Willow Grace Wellness Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANGIE MARTIN MACON MSW, LICSW, PIP (THERAPITST)
(205) 613-0764
Entity
Organization
Contact information
Practice address
2028 KENTUCKY AVE STE 101&103, VESTAVIA HILLS, AL 35216-1946
(205) 613-0764
Mailing address
2028 KENTUCKY AVE STE 101&103, VESTAVIA HILLS, AL 35216-1946
(205) 613-0764
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/13/2021
Last updated
06/13/2021
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