Organization
SOUTHEAST ALABAMA YOUTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA DANIELLE GORDON (PROGRAM DIRECTOR)
(334) 983-8377
Entity
Organization
Contact information
Practice address
76 VICTORIA ST, LOUISVILLE, AL 36048-3525
(334) 714-2549
Mailing address
2856 HORACE SHEPARD DR, DOTHAN, AL 36303-1007
(334) 714-2549
(334) 983-1289
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
08/15/2022
Last updated
08/15/2022
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