Healthcare Provider Details

I. General information

NPI: 1013050376
Provider Name (Legal Business Name): CLIFTON R. WINSLETT M. ED., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4984 MEADOW BROOK RD MEADOW BROOK BAPTIST CHURCH
BIRMINGHAM AL
35242-3133
US

IV. Provider business mailing address

30 OLD LOKEY FERRY RD
WILSONVILLE AL
35186-8104
US

V. Phone/Fax

Practice location:
  • Phone: 205-669-3225
  • Fax: 205-669-5259
Mailing address:
  • Phone: 205-669-3225
  • Fax: 205-669-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1553
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: