Healthcare Provider Details

I. General information

NPI: 1841593241
Provider Name (Legal Business Name): JORGE ALBERTO LIMA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 HOMER CLAYTON DR
GUNTERSVILLE AL
35976-2207
US

IV. Provider business mailing address

2409 HOMER CLAYTON DR
GUNTERSVILLE AL
35976-2207
US

V. Phone/Fax

Practice location:
  • Phone: 256-582-3203
  • Fax: 256-582-4161
Mailing address:
  • Phone: 256-582-3203
  • Fax: 256-582-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010040559
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: