Healthcare Provider Details

I. General information

NPI: 1952673576
Provider Name (Legal Business Name): GINGER L CAUDELL ALC, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 PELHAM RD S SUITE 2
JACKSONVILLE AL
36265-2772
US

IV. Provider business mailing address

PO BOX 1162
JACKSONVILLE AL
36265-5162
US

V. Phone/Fax

Practice location:
  • Phone: 256-239-5662
  • Fax: 256-217-4162
Mailing address:
  • Phone: 256-239-5662
  • Fax: 256-217-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1716A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: