Provider Demographics
NPI:1023397379
Name:STROTHER, MARY J (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:STROTHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:KEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6903
Mailing Address - Country:US
Mailing Address - Phone:334-702-7222
Mailing Address - Fax:334-712-0972
Practice Address - Street 1:101 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-6903
Practice Address - Country:US
Practice Address - Phone:334-702-7222
Practice Address - Fax:334-712-0972
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL129599Medicaid