Individual
MRS. TIERRA EZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ALC
Contact information
Practice address
7643 BROOME CT, THEODORE, AL 36582-6312
(251) 402-9072
Mailing address
7643 BROOME CT, THEODORE, AL 36582-6312
(251) 402-9072
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
ALC04247
AL
Other
Enumeration date
04/21/2023
Last updated
04/24/2023
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