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3 Annie Ct Fort Mitchell AL 36856-4439 | |
| (571) 222-5381 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3 Annie Ct, Fort Mitchell, Alabama |
| Authorized Official Name and Position | Kjerstin J Lemke (CLINICAL DIRECTOR) |
| Authorized Official Contact | 5712225381 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
120 19th St N Ste 201 120202 Birmingham AL 35203 Ph: () - | 3 Annie Ct Fort Mitchell AL 36856-4439 Ph: (571) 222-5381 |
| NPI Number | 1225895964 |
|---|---|
| Provider Enumeration Date | 02/29/2024 |
| Last Update Date | 08/27/2024 |
| Certification Date | 08/27/2024 |
| Medicare PECOS PAC ID | 9335674233 |
|---|---|
| Medicare Enrollment ID | O20241202002806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225895964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kjerstin Lemke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528649191 PECOS PAC ID: 2264874965 Enrollment ID: I20241204002807 |