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General NPI Number Information
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NPI Number | 1760405070
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Entity Type | Individual
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Provider Name | NANCY L SACK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 10/02/2021
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Provider Practice Location Address
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Address Line | 259 OLD JASMINE HILL RD
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City | WETUMPKA
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State | AL
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Zip | 36093-3421
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Country | US
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Telephone | 334-590-8492
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Fax | 334-270-9757
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Provider Business Mailing Address
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Address Line | 6701 WINTON BLOUNT BLVD UNIT 242972
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City | MONTGOMERY
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State | AL
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Zip | 36124-5139
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Country | US
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Telephone | 334-590-8492
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Fax | 334-270-9757
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 691
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License Number State | AL
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