Healthcare Provider Details

I. General information

NPI: 1396374195
Provider Name (Legal Business Name): ALABAMA DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 LEE ST NE STE 150
DECATUR AL
35601-1902
US

IV. Provider business mailing address

401 LEE ST NE STE 150
DECATUR AL
35601-1902
US

V. Phone/Fax

Practice location:
  • Phone: 205-478-3402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ANNA MCCONNELL
Title or Position: DIRECTOR
Credential:
Phone: 205-478-3402