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General NPI Number Information
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NPI Number | 1396304713
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Entity Type | Individual
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Provider Name | SHELANDA JONES KIMBROUGH ALC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 15181 HIGHWAY 43
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City | WAGARVILLE
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State | AL
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Zip | 36585-7000
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Country | US
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Telephone | 205-515-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 15181 HIGHWAY 43
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City | WAGARVILLE
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State | AL
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Zip | 36585-7000
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Country | US
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Telephone | 205-515-3377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCO4465
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C3185A
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License Number State | AL
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