Healthcare Provider Details

I. General information

NPI: 1063988400
Provider Name (Legal Business Name): DALLAS COUNTY FAMILY RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10096 AL HIGHWAY 14 W
SELMA AL
36701-1657
US

IV. Provider business mailing address

PO BOX 2142
SELMA AL
36702-2142
US

V. Phone/Fax

Practice location:
  • Phone: 334-874-7785
  • Fax:
Mailing address:
  • Phone: 334-874-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES THOMAS
Title or Position: EXECUTIVE DIRECTOR/ COUNSELOR
Credential: ALC, NCC
Phone: 334-874-7785