Healthcare Provider Details

I. General information

NPI: 1154073328
Provider Name (Legal Business Name): LICENSE PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BEL AIR BLVD STE 33
MOBILE AL
36606-3529
US

IV. Provider business mailing address

605 BEL AIR BLVD STE 33
MOBILE AL
36606-3529
US

V. Phone/Fax

Practice location:
  • Phone: 251-444-9740
  • Fax: 251-478-5050
Mailing address:
  • Phone: 251-444-9740
  • Fax: 251-478-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: VERONICA DAVIS
Title or Position: CEO/LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 251-444-9740