Healthcare Provider Details

I. General information

NPI: 1780635714
Provider Name (Legal Business Name): RENEA DONZELL MOTTE LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

244 CEDAR CRST
TUSCALOOSA AL
35401-3253
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax: 205-933-4474
Mailing address:
  • Phone: 205-933-8101
  • Fax: 205-933-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2119G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: