=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023871399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AISHA LA'SHUN PRATT-KILLIAN LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2024
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 20TH ST S FL 4
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-975-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2612 SHOEMAKER ST
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35235-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-566-1122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6535G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------