# INTERVENTION SERVICES OF SOUTHEAST ALABAMA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285340406
- **Authorized official:** MRS. JESSYCA RENAE COLEMAN LICSW-S (THERAPIST)
- **Authorized official phone:** (334) 406-0816

## Contact information

- **Practice address:** 557 GLOVER AVE, ENTERPRISE, AL 36330-2024
- **Practice address phone:** (334) 308-2292
- **Mailing address:** 108 CREST HILL DR, ENTERPRISE, AL 36330-4474
- **Mailing address phone:** (334) 406-0816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2023
- **Last updated:** 01/31/2023