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General NPI Number Information
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NPI Number | 1043955032
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Entity Type | Organization
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Legal Business Name | AXIA BEHAVIORAL GROUP, LLC
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 3840 RIDGEWAY DR
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City | HOMEWOOD
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State | AL
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Zip | 35209-5506
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Country | US
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Telephone | 205-913-7910
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Fax |
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Provider Business Mailing Address
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Address Line | 678 CHELSEA STATION CIR
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City | CHELSEA
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State | AL
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Zip | 35043-3081
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | WILLIAM FORD
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Credential | PHD
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Telephone | 205-913-7910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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