Healthcare Provider Details

I. General information

NPI: 1053457861
Provider Name (Legal Business Name): RICHARD FALLIN M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PROVIDENCE PARK STE 150
BIRMINGHAM AL
35242-7704
US

IV. Provider business mailing address

1000 PROVIDENCE PARK STE 150
BIRMINGHAM AL
35242-7704
US

V. Phone/Fax

Practice location:
  • Phone: 205-775-7757
  • Fax:
Mailing address:
  • Phone: 205-775-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3085
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: