Healthcare Provider Details

I. General information

NPI: 1871407445
Provider Name (Legal Business Name): LORI MCKIBBEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ADRIS PL STE B
DOTHAN AL
36303-1997
US

IV. Provider business mailing address

111 TUSCANY LN
DOTHAN AL
36301-4969
US

V. Phone/Fax

Practice location:
  • Phone: 334-625-7626
  • Fax: 334-460-4344
Mailing address:
  • Phone: 334-625-7626
  • Fax: 334-460-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3334G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: