Healthcare Provider Details

I. General information

NPI: 1780197970
Provider Name (Legal Business Name): G-TEAM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W ALABAMA ST
FLORENCE AL
35630-5516
US

IV. Provider business mailing address

218 W ALABAMA ST
FLORENCE AL
35630-5516
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-3007
  • Fax: 256-764-9132
Mailing address:
  • Phone: 256-764-3007
  • Fax: 256-764-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM G GRALL
Title or Position: PRESIDENT
Credential: MDIV, MA, LPC
Phone: 256-764-3007