Healthcare Provider Details

I. General information

NPI: 1912236779
Provider Name (Legal Business Name): WINDS OF CHANGE PSYCHOLOGICAL SERVICES OF MOBILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 PICCADILLY SQUARE DR
MOBILE AL
36609-5103
US

IV. Provider business mailing address

15360 CLARK RD
CODEN AL
36523-3206
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5300
  • Fax: 251-343-6613
Mailing address:
  • Phone: 251-824-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number961
License Number StateHI

VIII. Authorized Official

Name: JENNIFER LYNN ADAMS
Title or Position: CEO, PRESIDENT
Credential: PH.D.
Phone: 251-824-8602