Healthcare Provider Details

I. General information

NPI: 1356106488
Provider Name (Legal Business Name): WANDA EVETTE BROWN ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL DR
DOTHAN AL
36303-6903
US

IV. Provider business mailing address

101 MEDICAL DR
DOTHAN AL
36303-6903
US

V. Phone/Fax

Practice location:
  • Phone: 334-464-2164
  • Fax:
Mailing address:
  • Phone: 334-464-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: