Healthcare Provider Details

I. General information

NPI: 1538095484
Provider Name (Legal Business Name): BRE'YANA MICHELLE STALLWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BOULEVARD PARK E
MOBILE AL
36609-3425
US

IV. Provider business mailing address

505 BOULEVARD PARK E
MOBILE AL
36609-3425
US

V. Phone/Fax

Practice location:
  • Phone: 251-340-2020
  • Fax: 251-973-8201
Mailing address:
  • Phone: 251-340-2020
  • Fax: 251-973-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-547131
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: