Healthcare Provider Details

I. General information

NPI: 1083491385
Provider Name (Legal Business Name): JALYN CHAUNTESE HARRIS ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 HUFFMAN RD
BIRMINGHAM AL
35215-8300
US

IV. Provider business mailing address

524 HUFFMAN RD
BIRMINGHAM AL
35215-8300
US

V. Phone/Fax

Practice location:
  • Phone: 205-994-4563
  • Fax: 205-206-7131
Mailing address:
  • Phone: 205-994-4563
  • Fax: 205-206-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC04505
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: