Healthcare Provider Details

I. General information

NPI: 1346867496
Provider Name (Legal Business Name): ALABAMA CENTER FOR INDIVIDUAL & FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2020
Last Update Date: 07/05/2020
Certification Date: 07/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 WESTCORP BLVD SW STE 213D
HUNTSVILLE AL
35805-6411
US

IV. Provider business mailing address

100 CHELLE MILL LN
HAZEL GREEN AL
35750-5802
US

V. Phone/Fax

Practice location:
  • Phone: 256-581-4673
  • Fax: 256-602-2115
Mailing address:
  • Phone: 773-454-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ARIELLE NICOLE FEGGINS
Title or Position: OWNER
Credential: MS
Phone: 256-581-4673