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General NPI Number Information
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NPI Number | 1790007011
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Entity Type | Organization
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Legal Business Name | SYNCHRONICITY MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 468 PHILLIPS RD
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City | COTTONWOOD
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State | AL
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Zip | 36320-4248
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Country | US
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Telephone | 334-648-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 468 PHILLIPS RD
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City | COTTONWOOD
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State | AL
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Zip | 36320-4248
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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 | CEO
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Name | STARLA RAIBORN
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Credential |
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Telephone | 334-648-6867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 962
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License Number State | AL
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