Healthcare Provider Details

I. General information

NPI: 1841317450
Provider Name (Legal Business Name): CENTER FOR COUNSELING & HUMAN DEVELOPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 KATHERINE AVE
OZARK AL
36360
US

IV. Provider business mailing address

191 KATHERINE AVE
OZARK AL
36360
US

V. Phone/Fax

Practice location:
  • Phone: 334-774-7704
  • Fax: 334-774-7704
Mailing address:
  • Phone: 334-774-7704
  • Fax: 334-774-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. THERON MICHAEL COVIN
Title or Position: EXECUTIVE DIRECTOR
Credential: EBD
Phone: 336-774-7704