Healthcare Provider Details

I. General information

NPI: 1639092372
Provider Name (Legal Business Name): CHRISTINA CONNALLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 CALDWELL MILL RD
BIRMINGHAM AL
35242-4545
US

IV. Provider business mailing address

4103 FOREST LAKES RD
STERRETT AL
35147-8169
US

V. Phone/Fax

Practice location:
  • Phone: 205-533-8088
  • Fax: 205-431-3412
Mailing address:
  • Phone: 205-577-8297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06125
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: