Healthcare Provider Details

I. General information

NPI: 1013746056
Provider Name (Legal Business Name): IMPACT BEHAVIORAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E STE 453
BIRMINGHAM AL
35235-3472
US

IV. Provider business mailing address

48 MEDICAL PARK DR E STE 453
BIRMINGHAM AL
35235-3472
US

V. Phone/Fax

Practice location:
  • Phone: 205-208-9312
  • Fax: 205-848-2227
Mailing address:
  • Phone: 205-208-9312
  • Fax: 205-848-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK COMBS
Title or Position: CEO
Credential:
Phone: 205-208-9312