Healthcare Provider Details

I. General information

NPI: 1881628162
Provider Name (Legal Business Name): SOUTHWEST ALABAMA BEHAVIORAL HEALTH CARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 WEST CLAIBORNE STREET
MONROEVILLE AL
36460
US

IV. Provider business mailing address

PO BOX 964 328 WEST CLAIBORNE STREET
MONROEVILLE AL
36461-0964
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-4203
  • Fax:
Mailing address:
  • Phone: 251-575-4203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CANDACE HARDEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-575-4203