Healthcare Provider Details

I. General information

NPI: 1679186464
Provider Name (Legal Business Name): JACQUELYN ALISHA OVERSTREET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTERVIEW DR STE 201
VESTAVIA HILLS AL
35216-3747
US

IV. Provider business mailing address

6451 FREDA DR
PINSON AL
35126-3115
US

V. Phone/Fax

Practice location:
  • Phone: 205-807-5372
  • Fax:
Mailing address:
  • Phone: 205-427-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: