Healthcare Provider Details

I. General information

NPI: 1760161145
Provider Name (Legal Business Name): SHALESE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CAHABA PARK CIR STE 218
BIRMINGHAM AL
35242-8118
US

IV. Provider business mailing address

4890 UNIVERSITY SQ STE 7
HUNTSVILLE AL
35816-1896
US

V. Phone/Fax

Practice location:
  • Phone: 205-614-3191
  • Fax:
Mailing address:
  • Phone: 256-387-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberA332
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: