Healthcare Provider Details

I. General information

NPI: 1730895863
Provider Name (Legal Business Name): CHEQUETTA BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 OLIVE ST
MONTGOMERY AL
36106-1142
US

IV. Provider business mailing address

PO BOX 3223
MONTGOMERY AL
36109-0223
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-7830
  • Fax:
Mailing address:
  • Phone: 334-279-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC03884
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: