Healthcare Provider Details

I. General information

NPI: 1528991445
Provider Name (Legal Business Name): CALEB JOHN RACKARD ALC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701B GAULT AVE N
FORT PAYNE AL
35967-2627
US

IV. Provider business mailing address

PO BOX 316
COLLINSVILLE AL
35961-0316
US

V. Phone/Fax

Practice location:
  • Phone: 256-979-1620
  • Fax:
Mailing address:
  • Phone: 256-641-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06040
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: