| Name: | Lake Martin Family Therapy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 05 Sep 2007 (17 years ago) |
| Date of dissolution: | 25 Apr 2017 |
| Entity Number: | 000-499-475 |
| Register Number: | 000499475 |
| County: | Tallapoosa |
| Place of Formation: | Tallapoosa County |
| Principal Address: | ALEXANDER CITY, AL |
| Registered Office Street Address: | 393 GREEN STALEXANDER CITY, AL 35010 |
| Registered Office Street Address ZIP Code: | 35010 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497904312 | 2008-09-16 | 2008-09-16 | PO BOX 911, ALEXANDER CITY, AL, 350110911, US | 393 GREEN ST, ALEXANDER CITY, AL, 350101407, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-625-9514 |
| Fax | 2568256418 |
Authorized person
| Name | KAREN C. LEWIS |
| Role | MEMBER/OWNER |
| Phone | 2566259514 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | 2121C |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 106H00000X - Marriage & Family Therapist |
| License Number | L 299 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | ALABAMA BOARD OF EXAMINERS IN MARRIAGE & FAMILY THERAPY |
| Number | L 299 |
| State | AL |
| Issuer | STATE OF ALABAMA BOARD OF SOCIAL WORK EXMAINERS |
| Number | 2121C |
| State | AL |
| Name | Role |
|---|---|
| LEWIS, KAREN C | Agent |
| Name | Role |
|---|---|
| LEWIS, KAREN C | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
