Healthcare Provider Details

I. General information

NPI: 1730431164
Provider Name (Legal Business Name): MILESTONES PSYCHOLOGY AND THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTSIDE DR.
DOTHAN AL
36303
US

IV. Provider business mailing address

100 WESTSIDE DR.
DOTHAN AL
36303
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-2237
  • Fax: 334-712-6256
Mailing address:
  • Phone: 334-793-2237
  • Fax: 334-712-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. RICHARD DISMUKES
Title or Position: PRESIDENT
Credential: LPC
Phone: 334-793-2237