Healthcare Provider Details

I. General information

NPI: 1558817999
Provider Name (Legal Business Name): PAMELA DANNETTE BIVINS LPC-S,LMFT,NCC,JSOCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SOUTHLAKE LN STE 370
HOOVER AL
35244-3327
US

IV. Provider business mailing address

15 SOUTHLAKE LN STE 370
HOOVER AL
35244-3327
US

V. Phone/Fax

Practice location:
  • Phone: 205-201-0060
  • Fax: 833-853-4391
Mailing address:
  • Phone: 205-201-0060
  • Fax: 833-853-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3780
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL545
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: