Healthcare Provider Details

I. General information

NPI: 1023254968
Provider Name (Legal Business Name): LEADERSHIP PROFESSIONIALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511A RAINBOW DR
GADSDEN AL
35901-5370
US

IV. Provider business mailing address

1511A RAINBOW DR
GADSDEN AL
35901-5370
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-8880
  • Fax: 256-543-8889
Mailing address:
  • Phone: 256-543-8880
  • Fax: 256-543-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JACKY BACK
Title or Position: PRESIDENT
Credential: PHD
Phone: 256-543-8880