Healthcare Provider Details

I. General information

NPI: 1154754661
Provider Name (Legal Business Name): ALABAMA MEDIATION AND FAMILY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 GADSDEN HWY STE 149
BIRMINGHAM AL
35235-3266
US

IV. Provider business mailing address

1352 CALISTON WAY
PELHAM AL
35124-6226
US

V. Phone/Fax

Practice location:
  • Phone: 205-503-1643
  • Fax:
Mailing address:
  • Phone: 205-230-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1228
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1228
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1228
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1228
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1228
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1228
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1228
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1228
License Number StateAL
# 9
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1228
License Number StateAL
# 10
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1228
License Number StateAL
# 11
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number1228
License Number StateAL

VIII. Authorized Official

Name: SHARON D WALTZ
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential:
Phone: 205-503-1643