Healthcare Provider Details

I. General information

NPI: 1750435608
Provider Name (Legal Business Name): DUSTRINE B LAMBERT SR. LCSW PIP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 EAST COY SMITH HIGHWAY
MT VERNON AL
36560
US

IV. Provider business mailing address

PO BOX 1090
MT VERNON AL
36560
US

V. Phone/Fax

Practice location:
  • Phone: 251-662-6700
  • Fax: 251-829-5385
Mailing address:
  • Phone: 251-662-6700
  • Fax: 251-829-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0219C PIP013 0219C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: