Healthcare Provider Details

I. General information

NPI: 1265693402
Provider Name (Legal Business Name): SPORTS/EDUCATION/ART (SEA)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WIMBLEDON DRIVE
MOBILE AL
36608
US

IV. Provider business mailing address

6725 #51 ZEIGLER BLVD.
MOBILE AL
36608
US

V. Phone/Fax

Practice location:
  • Phone: 251-644-1585
  • Fax:
Mailing address:
  • Phone: 251-348-2158
  • Fax: 251-348-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number84038
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 12
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number680202508
License Number StateMI

VIII. Authorized Official

Name: DR. DORIS JEAN-WILLIAMS BROWN
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 251-348-2158