Healthcare Provider Details

I. General information

NPI: 1912812660
Provider Name (Legal Business Name): TAKESHIA HALL-HUMPHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7358 US HIGHWAY 231
WETUMPKA AL
36092-2053
US

IV. Provider business mailing address

7358 US HIGHWAY 231
WETUMPKA AL
36092-2053
US

V. Phone/Fax

Practice location:
  • Phone: 334-245-4080
  • Fax: 334-269-7826
Mailing address:
  • Phone: 334-245-4080
  • Fax: 334-269-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC06144
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: