Facts
- Status
- A
- Credential
- LICSW
- Type
- Individual
- Enumeration date
- 2016-04-20
- Last updated
- 2021-01-27
Licenses
- License MS
- M8271
- License AL
- 4472C
Location
- Practice location
- 2400 HOSPITAL RD
- City
- TUSKEGEE AL
- Postal code
- 360835001
- Phone
- 334-272-4670
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.