Healthcare Provider Details

I. General information

NPI: 1942426804
Provider Name (Legal Business Name): SOUTHERN PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 AZALEA RD ONE OFFICE PARK, SUITE 305
MOBILE AL
36609-1970
US

IV. Provider business mailing address

6758 STONERIDGE CT
MOBILE AL
36695-3061
US

V. Phone/Fax

Practice location:
  • Phone: 251-323-2022
  • Fax:
Mailing address:
  • Phone: 251-776-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number886
License Number StateAL

VIII. Authorized Official

Name: DR. KIM MICHELLE ZWEIFLER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 251-343-2022