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General NPI Number Information
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NPI Number | 1104051747
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Entity Type | Organization
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Legal Business Name | COGNITIVE CENTERS OF AMERICA, LLC
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 631 BEACON PKWY W SUITE 203
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3124
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Country | US
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Telephone | 205-641-2975
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Fax | 888-773-3586
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Provider Business Mailing Address
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Address Line | 9340 HELENA RD SUITE F-414
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City | HOOVER
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State | AL
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Zip | 35244-1794
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Country | US
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Telephone | 205-641-2975
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Fax | 888-773-3586
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. DONALD H. MARKS
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Credential | M.D, PH.D.
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Telephone | 205-283-1688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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