Organization · Type 2 NPI

Tabia Keonna Woolfork Recreational Mental Health Fitness Facility

Mental Health Clinic/Center (Including Community Mental Health Center) · Montgomery, AL

NPI number 1639805500 Active

Practice location

853 S Court St
Montgomery, AL 36104-4905

Call (334) 647-1880 Map

Mailing address

6021 Portsmouth Ct
Montgomery, AL 36116-7103

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

Another provider at this address

Peggie Lee Hatten, BA, MD, SACAddiction (Substance Use Disorder) Counselor Montgomery, AL NPI 1568123578

Other mental health clinic/center (including community mental health center) providers in Montgomery

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NPI record

NPI: 1639805500
Entity type: Organization (Type 2)
Issued: Jul 25, 2022
Last updated: Jul 25, 2022
Status: Active

Other names

Tabia Keonna Woolfork Recreational Mental Health Fitness Facility · former legal business name

Authorized official

Peggie Lee Hatten, ALC
Founder
(334) 647-1880

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1639805500

Tabia Keonna Woolfork Recreational Mental Health Fitness Facility's National Provider Identifier is 1639805500, issued on Jul 25, 2022. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Montgomery, AL. The record was last updated on Jul 25, 2022.