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General NPI Number Information
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NPI Number | 1780354746
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Entity Type | Organization
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Legal Business Name | PRISM COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 05/11/2025
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Provider Practice Location Address
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Address Line | 175 N DALEVILLE AVE STE A
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City | DALEVILLE
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State | AL
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Zip | 36322-2019
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Country | US
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Telephone | 334-475-3729
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Fax |
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Provider Business Mailing Address
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Address Line | 175 NORTH DALEVILLE AVE SUITE A
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City | DALEVILLE
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State | AL
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Zip | 36322
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Country | US
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Telephone | 334-475-3729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA EZELL
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Credential | LPC, NCC, BC-TMH
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Telephone | 334-475-3729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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