Healthcare Provider Details

I. General information

NPI: 1477179190
Provider Name (Legal Business Name): DONICA PUGH ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 GADSDEN HWY STE 102
BIRMINGHAM AL
35235-1022
US

IV. Provider business mailing address

266 GADSDEN HWY STE 102
BIRMINGHAM AL
35235-1022
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3544
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: