Healthcare Provider Details

I. General information

NPI: 1629997747
Provider Name (Legal Business Name): MARISOL ECHEVERRIA GEDEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 HIGHWAY 280 E APT 1434
VESTAVIA AL
35243-2718
US

IV. Provider business mailing address

3090 US-280 E 1434
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 925-639-5102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC05824
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: