Healthcare Provider Details

I. General information

NPI: 1124339908
Provider Name (Legal Business Name): TERESA ADAMS HOLMES M.S. ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 S STATE HIGHWAY 103
SLOCOMB AL
36375-5792
US

IV. Provider business mailing address

6276 S STATE HIGHWAY 103
SLOCOMB AL
36375-5792
US

V. Phone/Fax

Practice location:
  • Phone: 334-798-5015
  • Fax: 334-886-3932
Mailing address:
  • Phone: 334-798-5015
  • Fax: 334-886-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1635A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: