Healthcare Provider Details

I. General information

NPI: 1114848348
Provider Name (Legal Business Name): GENICE LOUISE CHILDRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 VALLEYDALE DR
VALLEY GRANDE AL
36703-9305
US

IV. Provider business mailing address

156 VALLEYDALE DR
VALLEY GRANDE AL
36703-9305
US

V. Phone/Fax

Practice location:
  • Phone: 334-412-0143
  • Fax:
Mailing address:
  • Phone: 334-412-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7513G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: