Provider Demographics
NPI:1033743927
Name:DUDLEY, ROSALYN (LPC)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-0627
Mailing Address - Country:US
Mailing Address - Phone:256-683-0044
Mailing Address - Fax:
Practice Address - Street 1:7951 GRISTMILL DR
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:AL
Practice Address - Zip Code:35111-3057
Practice Address - Country:US
Practice Address - Phone:256-683-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AL4551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)