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NPI Code Detail

MEDICARE: VENECIA SUMMERVILLE MSW

MEDICARE: VENECIA SUMMERVILLE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1548834484
Entity Type Code : Individual
Provider Name (Legal Business Name) : VENECIA SUMMERVILLE MSW
Provider Business Mailing Address
First Line : PO BOX 403
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35201-0403
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2501 INTERNATIONAL PARK DR
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35243-4253
Country : US
Telephone Number : 205-813-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2021
Last Update Date : 05/15/2021

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