Healthcare Provider Details

I. General information

NPI: 1801210737
Provider Name (Legal Business Name): PREMIER BUSINESS DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 OLD TUSCALOOSA HIGHWAY
MCCALLA AL
35111-0737
US

IV. Provider business mailing address

PO BOX 737
MC CALLA AL
35111-0737
US

V. Phone/Fax

Practice location:
  • Phone: 205-477-9866
  • Fax:
Mailing address:
  • Phone: 205-477-9866
  • Fax: 888-769-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY CARTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 205-477-9866