Healthcare Provider Details

I. General information

NPI: 1407186703
Provider Name (Legal Business Name): CHAD KNIGHT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 SARDIS DR
BOAZ AL
35956-2344
US

IV. Provider business mailing address

604 8TH AVE NE
JACKSONVILLE AL
36265-1728
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-2371
  • Fax:
Mailing address:
  • Phone: 256-343-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2427C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: