Individual
MRS. BRENDA VACTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, PIP
Contact information
Practice address
3007 MEMORIAL PKWY SW # SX, HUNTSVILLE, AL 35801-5393
(256) 882-2003
(256) 705-4630
Mailing address
3007 MEMORIAL PKWY SW, HUNTSVILLE, AL 35801-5393
(256) 882-2003
(256) 705-4630
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
1692C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063420644
ALLKIDS
AL
Enumeration date
08/03/2006
Last updated
03/07/2017
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