Healthcare Provider Details

I. General information

NPI: 1639287857
Provider Name (Legal Business Name): CHILD & ADOLESCENT PSYCHOLOGICAL SERVICES OF INVERNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 VALLEYDALE RD SUITE A1
BIRMINGHAM AL
35242-4654
US

IV. Provider business mailing address

4898 VALLEYDALE RD SUITE A1
BIRMINGHAM AL
35242-4654
US

V. Phone/Fax

Practice location:
  • Phone: 205-981-1330
  • Fax: 205-981-1390
Mailing address:
  • Phone: 205-981-1330
  • Fax: 205-981-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1077
License Number StateAL

VIII. Authorized Official

Name: DR. MICHAEL DAVID FETTER
Title or Position: OWNER/PRESIDENT
Credential: PH.D.
Phone: 205-981-1330