Healthcare Provider Details

I. General information

NPI: 1093273120
Provider Name (Legal Business Name): MARICELLY SAXON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALI SAXON ALC

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GLOVER AVE STE 3
ENTERPRISE AL
36330-2070
US

IV. Provider business mailing address

557 GLOVER AVE STE 3
ENTERPRISE AL
36330-2070
US

V. Phone/Fax

Practice location:
  • Phone: 334-347-1862
  • Fax: 334-347-2919
Mailing address:
  • Phone: 334-347-1862
  • Fax: 334-347-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: