Individual
BRANCH ACTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
3918 MONTCLAIR RD STE 206, MOUNTAIN BRK, AL 35213-2418
(205) 919-1902
(205) 278-5304
Mailing address
3918 MONTCLAIR RD STE 206, MOUNTAIN BRK, AL 35213-2418
(205) 919-1902
(205) 278-5304
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5347C
AL
Other
Enumeration date
05/04/2023
Last updated
04/22/2024
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