Healthcare Provider Details

I. General information

NPI: 1275313355
Provider Name (Legal Business Name): PRIANA LYNA COMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MERIDIAN ST N BUCHANAN HALL, BUCHANAN WAY SUITE 124
NORMAL AL
35762
US

IV. Provider business mailing address

1435 10TH ST NE
CANTON OH
44705-1361
US

V. Phone/Fax

Practice location:
  • Phone: 330-413-6614
  • Fax:
Mailing address:
  • Phone: 330-413-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: