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3413 Rainbow Pkwy Ste A Rainbow City AL 35906-3234 | |
| (256) 490-6423 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3413 Rainbow Pkwy Ste A, Rainbow City, Alabama |
| Authorized Official Name and Position | Kenneth Street (OWNER) |
| Authorized Official Contact | 2564906423 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3413 Rainbow Pkwy Ste A Rainbow City AL 35906-3234 Ph: (256) 225-3659 | 3413 Rainbow Pkwy Ste A Rainbow City AL 35906-3234 Ph: (256) 490-6423 |
| NPI Number | 1689111361 |
|---|---|
| Provider Enumeration Date | 01/19/2017 |
| Last Update Date | 01/30/2025 |
| Certification Date | 01/30/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689111361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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