| Illuminate Group LLC | |
|
1040 Stanton Rd Suite H Daphne AL 36526 | |
| (251) 517-5398 | |
| Not Available |
| Full Name | Illuminate Group LLC |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1040 Stanton Rd, Daphne, Alabama |
| Authorized Official Name and Position | Thomas Casolaro (FOUNDER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 2515175398 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminate Group LLC Po Box 478 Fairhope AL 36533-0478 Ph: (251) 517-5398 | Illuminate Group LLC 1040 Stanton Rd Suite H Daphne AL 36526 Ph: (251) 517-5398 |
| NPI Number | 1063236214 |
|---|---|
| Provider Enumeration Date | 11/14/2024 |
| Last Update Date | 11/14/2024 |
| Certification Date | 11/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063236214 | NPI | - | NPPES |
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