MEDICARE: JILLIAN DALE ALC

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	ALC04163	AL

General Provider Information

NPI Number	:	1851134316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN DALE ALC

Provider Business Mailing Address
First Line	:	1208 TURF DR
Second Line	:
City	:	CENTER POINT
State	:	AL
Zip	:	35215-3911
Country	:	US
Telephone Number	:	205-212-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 INTERNATIONAL PARK DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-4252
Country	:	US
Telephone Number	:	205-813-7403
Fax Number	:

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

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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Directions to “ JILLIAN DALE ALC” Practice Location

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