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General NPI Number Information
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NPI Number | 1285019927
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Entity Type | Organization
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Legal Business Name | PSYCHIATRY 280 COUNSELING SERVICES INC
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 2803 GREYSTONE COMMERCIAL BLVD STE 12
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City | BIRMINGHAM
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State | AL
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Zip | 35242-9603
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Country | US
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Telephone | 205-968-1227
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Fax | 205-968-1229
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Provider Business Mailing Address
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Address Line | 2803 GREYSTONE COMMERCIAL BLVD STE 12
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City | BIRMINGHAM
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State | AL
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Zip | 35242-9603
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Country | US
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Telephone | 205-968-1227
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Fax | 205-968-1229
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | LANE GOULD-HARTLINE
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Credential | APRN
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Telephone | 205-968-1227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 1048511
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License Number State | AL
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