Healthcare Provider Details

I. General information

NPI: 1124186671
Provider Name (Legal Business Name): JEFFREY JOHN PAPPAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MONTLIMAR DR SUITE A-210
MOBILE AL
36609-1713
US

IV. Provider business mailing address

1015 MONTLIMAR DR SUITE A-210
MOBILE AL
36609-1713
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-4104
  • Fax: 251-343-4789
Mailing address:
  • Phone: 251-343-4104
  • Fax: 251-343-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0170C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: