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General NPI Number Information
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NPI Number | 1912029844
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Entity Type | Organization
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Legal Business Name | SOUTHEAST ALABAMA CHRISTIAN COUNSELING AND PSYCHOLOGICAL SERVICES INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 305 BRUNER MILL RD
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City | ASHFORD
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State | AL
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Zip | 36312-4515
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Country | US
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Telephone | 334-797-5893
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 361
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City | ASHFORD
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State | AL
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Zip | 36312-0361
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Country | US
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Telephone | 334-797-5893
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT T TUCKER
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Credential | PH.D.
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Telephone | 334-797-5893
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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 | 1389
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 1389
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1389
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 1389
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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