Healthcare Provider Details

I. General information

NPI: 1669752754
Provider Name (Legal Business Name): BIRMINGHAM ANXIETY AND TRAUMA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 INDEPENDENCE DR SUITE 100
BIRMINGHAM AL
35209-5668
US

IV. Provider business mailing address

3499 INDEPENDENCE DR SUITE 100
BIRMINGHAM AL
35209-5668
US

V. Phone/Fax

Practice location:
  • Phone: 205-807-5372
  • Fax: 205-413-8789
Mailing address:
  • Phone: 205-807-5372
  • Fax: 205-413-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1326
License Number StateAL

VIII. Authorized Official

Name: DR. DIANA LYNN PAULK
Title or Position: PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 205-807-5372