Healthcare Provider Details

I. General information

NPI: 1790008209
Provider Name (Legal Business Name): SOLOMON NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 PARLIAMENT CIR SUITE 400
MONTGOMERY AL
36116-7271
US

IV. Provider business mailing address

3196 PARLIAMENT CIR SUITE 400
MONTGOMERY AL
36116-7271
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-8949
  • Fax:
Mailing address:
  • Phone: 334-272-8949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1584
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1584
License Number StateAL

VIII. Authorized Official

Name: DR. ANDREA C SOLOMON
Title or Position: MEMBER/OWNER
Credential: PH.D.
Phone: 812-345-2585