Healthcare Provider Details

I. General information

NPI: 1174576318
Provider Name (Legal Business Name): WILLIAM LEE GASTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 20TH ST S
BIRMINGHAM AL
35205-4913
US

IV. Provider business mailing address

1401 20TH ST S
BIRMINGHAM AL
35205-4913
US

V. Phone/Fax

Practice location:
  • Phone: 205-510-2761
  • Fax: 205-510-2790
Mailing address:
  • Phone: 205-510-2761
  • Fax: 205-510-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1361C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: