Healthcare Provider Details

I. General information

NPI: 1164341491
Provider Name (Legal Business Name): KENISHIA PRITCHETT ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WIGGINS RD
JACKSON AL
36545-5335
US

IV. Provider business mailing address

207 WIGGINS RD
JACKSON AL
36545-5335
US

V. Phone/Fax

Practice location:
  • Phone: 334-327-3344
  • Fax:
Mailing address:
  • Phone: 334-327-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06043
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: