Organization
PROKIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID LOUIS ROBERTS PH.D. (PRESIDENT/CLINICAL PSYCHOLOGIST)
(251) 457-4170
Entity
Organization
Contact information
Practice address
321 ALPINE ST, MOBILE, AL 36611-2434
(251) 457-4170
(251) 259-5177
Mailing address
PO BOX 11452, MOBILE, AL 36671-0452
(251) 457-4170
(251) 259-5177
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
AL1353
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890013780
—
AL
Enumeration date
06/05/2009
Last updated
06/05/2009
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