Healthcare Provider Details

I. General information

NPI: 1205999455
Provider Name (Legal Business Name): SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 NOBLE ST
ANNISTON AL
36201-4693
US

IV. Provider business mailing address

3001 SCENIC HWY
GADSDEN AL
35904-3047
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-4755
  • Fax: 256-237-4749
Mailing address:
  • Phone: 256-546-9265
  • Fax: 256-549-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JOY R BALLENGER
Title or Position: CREDENTIALING NETWORK MANAGER
Credential:
Phone: 256-546-9265