Healthcare Provider Details

I. General information

NPI: 1629700679
Provider Name (Legal Business Name): BETTIE ROGERS DEAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY ABRAMS

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 GORDON SMITH DR
MOBILE AL
36617-2318
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-461-3491
  • Fax:
Mailing address:
  • Phone: 251-450-5916
  • Fax: 251-662-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4466
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: