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General NPI Number Information
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NPI Number | 1548722408
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Entity Type | Individual
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Provider Name | ABBY BROCK SANTIAGO LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 3000 RIVERCHASE GALLERIA STE 500
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City | HOOVER
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State | AL
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Zip | 35244-2365
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Country | US
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Telephone | 205-994-8811
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Fax | 205-994-8812
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Provider Business Mailing Address
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Address Line | 2650 WOODFERN CT
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City | HOMEWOOD
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State | AL
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Zip | 35209-1704
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Country | US
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Telephone | 205-960-8772
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4274C
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License Number State | AL
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