Healthcare Provider Details

I. General information

NPI: 1174945810
Provider Name (Legal Business Name): LEAH CASTILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 ROCKY RIDGE LN
BIRMINGHAM AL
35216-4809
US

IV. Provider business mailing address

2681 ROCKY RIDGE LN
BIRMINGHAM AL
35216-4809
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-0037
  • Fax:
Mailing address:
  • Phone: 205-945-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3355G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: