Healthcare Provider Details

I. General information

NPI: 1790608255
Provider Name (Legal Business Name): KERRIGAN TONEAH PHILLIPS ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

8942 AUTUMN BROOKE WAY
MONTGOMERY AL
36117-0902
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-2100
  • Fax:
Mailing address:
  • Phone: 513-462-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06123
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: