Healthcare Provider Details

I. General information

NPI: 1710513189
Provider Name (Legal Business Name): KEVIN J DUDECK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SLEDGE DR
MOBILE AL
36606-3021
US

IV. Provider business mailing address

1340 SLEDGE DR
MOBILE AL
36606-3021
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-3410
  • Fax: 251-476-4454
Mailing address:
  • Phone: 251-473-3410
  • Fax: 251-476-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4250
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: