Willow Grace Wellness Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WILLOW GRACE WELLNESS CENTER LLC

Doing business as

Willow Grace Wellness Center LLC

Practice address

2028 Kentucky Ave Ste 101&103
Vestavia Hills, AL 35216-1946

Phone

(205) 613-0764

NPI assigned

Jun 13, 2021

Last updated

Jun 13, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tangie Martin Macon, MSW, LICSW, PIPNPI 1598095895

Title

Therapitst

Phone

(205) 613-0764

Specialties & licenses 1

Addresses

Other names 1

• Willow Grace Wellness Center LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tangie Martin Macon, LCSW, PIP

  • Social Worker
  • Birmingham, AL
  • NPI 1598095895
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623542400000",
    "number": "1467020891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 KENTUCKY AVE STE 101&103",
            "city": "VESTAVIA HILLS",
            "state": "AL",
            "postal_code": "352161946",
            "telephone_number": "205-613-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 KENTUCKY AVE STE 101&103",
            "city": "VESTAVIA HILLS",
            "state": "AL",
            "postal_code": "352161946",
            "telephone_number": "205-613-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW GRACE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-13",
        "last_updated": "2021-06-13",
        "certification_date": "2021-06-13",
        "status": "A",
        "authorized_official_last_name": "MACON",
        "authorized_official_first_name": "TANGIE",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "THERAPITST",
        "authorized_official_telephone_number": "205-613-0764",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LICSW, PIP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Grace Wellness Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wildflower Counseling
• Christopher Williams II
• Dory Williams
• Laterica Williams, MSW
• Vanessa Marrero Williams, LICSW
• Amanda Wilson, ALC, MFT-A, NCC
• Caylar Love Wilson
• Sonya Wilson, LPC
• Jade E Witt, CO
• Diana Pearis Wood, DMD

• Clinical Social Worker in Vestavia Hills, AL
• Providers in Vestavia Hills, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.