Healthcare Provider Details

I. General information

NPI: 1245401447
Provider Name (Legal Business Name): BREWER PORCH CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WOODLAND RD
TUSCALOOSA AL
35404-5028
US

IV. Provider business mailing address

2501 WOODLAND RD
TUSCALOOSA AL
35404-5028
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-7236
  • Fax: 205-348-9368
Mailing address:
  • Phone: 205-348-7236
  • Fax: 205-348-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES WILLIAM THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 205-348-9340