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General NPI Number Information
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NPI Number | 1467235374
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Entity Type | Individual
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Provider Name | MEGYN AVEDISIAN MS, ALC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1736 OXMOOR RD STE 208
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City | HOMEWOOD
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State | AL
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Zip | 35209-4053
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Country | US
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Telephone | 205-538-3978
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Fax |
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Provider Business Mailing Address
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Address Line | 3578 SOUTHERN TRL
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City | FULTONDALE
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State | AL
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Zip | 35068-1921
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Country | US
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Telephone | 205-218-5471
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ALC04417
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License Number State | AL
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