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General NPI Number Information
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NPI Number | 1558799205
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Entity Type | Organization
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Legal Business Name | SOURCE FOR CHANGE COUNSELING
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 2909 CRESCENT AVE
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City | BIRMINGHAM
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State | AL
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Zip | 35209-2521
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Country | US
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Telephone | 205-585-8761
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Fax |
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Provider Business Mailing Address
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Address Line | 2448 WINE RIDGE DR
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City | BIRMINGHAM
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State | AL
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Zip | 35244-2426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANA SMALLWOOD
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Credential |
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Telephone | 205-585-8761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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