Healthcare Provider Details

I. General information

NPI: 1902649452
Provider Name (Legal Business Name): GULF COAST COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14251 MOFFETT RD
WILMER AL
36587-4103
US

IV. Provider business mailing address

14325A WARD RD
WILMER AL
36587-4001
US

V. Phone/Fax

Practice location:
  • Phone: 251-490-3927
  • Fax:
Mailing address:
  • Phone: 251-490-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CARPENTER
Title or Position: OWNER/COUNSELOR
Credential: ALC
Phone: 251-490-3927