Healthcare Provider Details

I. General information

NPI: 1770499865
Provider Name (Legal Business Name): MELISSA LONG MUNTHALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 CARMICHAEL RD STE 200-5
MONTGOMERY AL
36106-3614
US

IV. Provider business mailing address

4137 CARMICHAEL RD STE 200-5
MONTGOMERY AL
36106-3614
US

V. Phone/Fax

Practice location:
  • Phone: 334-633-5861
  • Fax: 334-367-1057
Mailing address:
  • Phone: 334-633-5861
  • Fax: 334-367-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberALC06150
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: