MEDICARE: MS. ALEXIS LONG-DANIELS M.A., ALC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C3229A	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1090779	OTHER	AL	NCC
2	C3229A	OTHER	AL	ALC

General Provider Information

NPI Number	:	1063971661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXIS LONG-DANIELS M.A., ALC, NCC

Provider Business Mailing Address
First Line	:	4737 SUMMER PLACE PKWY
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3095
Country	:	US
Telephone Number	:	404-405-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 3RD AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1628
Country	:	US
Telephone Number	:	205-910-4168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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