Healthcare Provider Details

I. General information

NPI: 1720539372
Provider Name (Legal Business Name): CARING CONFIDENTIAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 BROAD ST
PHIL CAMPBELL AL
35581-3600
US

IV. Provider business mailing address

3480 BROAD ST
PHIL CAMPBELL AL
35581-3600
US

V. Phone/Fax

Practice location:
  • Phone: 205-993-4556
  • Fax: 205-993-4556
Mailing address:
  • Phone: 205-993-4556
  • Fax: 205-993-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3397
License Number StateAL

VIII. Authorized Official

Name: BRUCE FORMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-993-4556