Individual
G TEAL DICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.DIV. LPC-S
Contact information
Practice address
1881 COUNTY ROAD 627, THORSBY, AL 35171-8151
(205) 389-2079
Mailing address
P.O. BOX 55, THORSBY, AL 35171-3428
(205) 389-2079
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1489
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11812892
CAQH
—
01
—
515-45395
BLUE CROSS BLUE SHIELD
AL
Enumeration date
05/06/2008
Last updated
10/27/2014
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