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3918 Montclair Rd Ste 206 Birmingham AL 35213-2418 | |
| (251) 408-2051 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 3918 Montclair Rd Ste 206, Birmingham, Alabama |
| Authorized Official Name and Position | Kent Watts (PRESIDENT) |
| Authorized Official Contact | 2514082051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2207 5th Ave S Irondale AL 35210-1632 Ph: (251) 408-2051 | 3918 Montclair Rd Ste 206 Birmingham AL 35213-2418 Ph: (251) 408-2051 |
| NPI Number | 1629789359 |
|---|---|
| Provider Enumeration Date | 12/13/2022 |
| Last Update Date | 03/25/2023 |
| Certification Date | 03/25/2023 |
| Medicare PECOS PAC ID | 1456716380 |
|---|---|
| Medicare Enrollment ID | O20230428001693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629789359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Destini Love |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629469168 PECOS PAC ID: 3375861651 Enrollment ID: I20230428001920 |
| Provider Name | Branch R. Acton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992494041 PECOS PAC ID: 3173970407 Enrollment ID: I20231108002531 |
| Provider Name | Marion Yvonne Coleman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477847259 PECOS PAC ID: 8022451251 Enrollment ID: I20240205003067 |
| Provider Name | Rebecca Ehrhardt Hedrick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871265264 PECOS PAC ID: 3870937576 Enrollment ID: I20240221002901 |
| Provider Name | Latrice Shonta Dailey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770058737 PECOS PAC ID: 6204273089 Enrollment ID: I20240328002607 |
| Provider Name | Katesha Lavett Ford |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568955698 PECOS PAC ID: 7315483104 Enrollment ID: I20240729003692 |
| Provider Name | Lauren Bartmess Foster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104501220 PECOS PAC ID: 0547793424 Enrollment ID: I20241030003498 |
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