Healthcare Provider Details

I. General information

NPI: 1801538178
Provider Name (Legal Business Name): JULIUS J TERRELL ALC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316-7268
US

IV. Provider business mailing address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316-7268
US

V. Phone/Fax

Practice location:
  • Phone: 334-237-3838
  • Fax: 334-489-4606
Mailing address:
  • Phone: 334-237-3838
  • Fax: 334-489-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC3708A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: