Healthcare Provider Details

I. General information

NPI: 1487489605
Provider Name (Legal Business Name): CORDELIA STANLEY ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 LEIGHTON AVE STE B
ANNISTON AL
36207-3805
US

IV. Provider business mailing address

1525 LEIGHTON AVE STE B
ANNISTON AL
36207-3805
US

V. Phone/Fax

Practice location:
  • Phone: 256-343-4080
  • Fax:
Mailing address:
  • Phone: 256-343-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC04909
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: