Organization
LEADERSHIP PROFESSIONIALS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKY BACK PHD (PRESIDENT)
(256) 543-8880
Entity
Organization
Contact information
Practice address
1511A RAINBOW DR, GADSDEN, AL 35901-5370
(256) 543-8880
(256) 543-8889
Mailing address
1511A RAINBOW DR, GADSDEN, AL 35901-5370
(256) 543-8880
(256) 543-8889
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51512565
BCBS
AL
Enumeration date
12/24/2008
Last updated
12/24/2008
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