Organization
EAST ALABAMA CENTER FOR CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER ELIZABETH DOUGLAS PSYD (LICENSED PSYCHOLOGIST)
(334) 734-2603
Entity
Organization
Contact information
Practice address
124 BRAGG AVE, AUBURN, AL 36830-3809
(334) 734-2603
(334) 887-0031
Mailing address
124 BRAGG AVE, AUBURN, AL 36830-3809
(334) 734-2603
(334) 887-0031
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
AL1749
AL
103TH0004X
Health Psychologist
AL1749
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I626774
MEDICARE PTAN
AL
Enumeration date
07/17/2015
Last updated
07/17/2015
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