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General NPI Number Information
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NPI Number | 1629388038
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Entity Type | Individual
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Provider Name | AUDREY RAE MAYNOR M..ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 150 GLENWOOD LN
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City | BIRMINGHAM
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State | AL
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Zip | 35242-5700
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Country | US
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Telephone | 205-795-3214
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 HENRY DR
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City | ALABASTER
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State | AL
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Zip | 35007-8947
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Country | US
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Telephone | 205-240-2372
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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 | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 2238
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License Number State | AL
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