1255869871 NPI number — COUNSELING SPECIALISTS OF BIRMINGHAM

Table of content: MISS BRIAN HOWARD ACKERSON MSW (NPI 1780976423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255869871 NPI number — COUNSELING SPECIALISTS OF BIRMINGHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING SPECIALISTS OF BIRMINGHAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255869871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3864 TIMBERLINE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35243-2452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-596-5756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1116 23RD ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-596-5756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KLYCE
Authorized Official First Name:
MAGGIE
Authorized Official Middle Name:
HILL
Authorized Official Title or Position:
THERAPIST/OWNER
Authorized Official Telephone Number:
770-596-5756

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3959C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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