Provider Demographics
NPI:1124186671
Name:PAPPAS, JEFFREY JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOHN
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MONTLIMAR DR
Mailing Address - Street 2:SUITE A-210
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1713
Mailing Address - Country:US
Mailing Address - Phone:251-343-4104
Mailing Address - Fax:251-343-4789
Practice Address - Street 1:1015 MONTLIMAR DR
Practice Address - Street 2:SUITE A-210
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1713
Practice Address - Country:US
Practice Address - Phone:251-343-4104
Practice Address - Fax:251-343-4789
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0170C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631049953OtherTAX ID
AL631049953OtherTAX ID