Healthcare Provider Details

I. General information

NPI: 1912029844
Provider Name (Legal Business Name): SOUTHEAST ALABAMA CHRISTIAN COUNSELING AND PSYCHOLOGICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BRUNER MILL RD
ASHFORD AL
36312-4515
US

IV. Provider business mailing address

PO BOX 361
ASHFORD AL
36312-0361
US

V. Phone/Fax

Practice location:
  • Phone: 334-797-5893
  • Fax:
Mailing address:
  • Phone: 334-797-5893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1389
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1389
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1389
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1389
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT T TUCKER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 334-797-5893