Healthcare Provider Details

I. General information

NPI: 1417878331
Provider Name (Legal Business Name): EDITH BARRINEAU KORTMAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OFFICE PARK DR STE 215
MOUNTAIN BRK AL
35223-2455
US

IV. Provider business mailing address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

V. Phone/Fax

Practice location:
  • Phone: 205-201-0338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3649C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: