Organization
THE CENTRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT EDWIN COLCLOUGH LPC (DIRECTOR)
(251) 625-0118
Entity
Organization
Contact information
Practice address
1290 MAIN ST STE E, DAPHNE, AL 36526-8624
(251) 625-0118
(251) 625-0116
Mailing address
1290 MAIN ST STE E, DAPHNE, AL 36526-8624
(251) 625-0118
(251) 625-0116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 111 AL
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515 92982
BLUE CROSS
AL
01
—
515 92986
BLUE CROSS ROBERT COLCLOUGH
AL
Enumeration date
08/27/2008
Last updated
09/16/2008
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