Healthcare Provider Details

I. General information

NPI: 1063320810
Provider Name (Legal Business Name): KOBI REBECA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 COUNTY ROAD 754
ENTERPRISE AL
36330-1271
US

IV. Provider business mailing address

477 COUNTY ROAD 754
ENTERPRISE AL
36330-1271
US

V. Phone/Fax

Practice location:
  • Phone: 334-470-9730
  • Fax:
Mailing address:
  • Phone: 334-470-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number262828060
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: