Healthcare Provider Details

I. General information

NPI: 1215989629
Provider Name (Legal Business Name): TOM S. ALSABROOK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 EDWARDS ST
MARION AL
36756-2304
US

IV. Provider business mailing address

475 MYCHAEL LN
CENTREVILLE AL
35042-4446
US

V. Phone/Fax

Practice location:
  • Phone: 334-683-9957
  • Fax: 334-683-4114
Mailing address:
  • Phone: 334-683-9957
  • Fax: 334-683-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number734
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: