Provider Demographics
NPI:1164140257
Name:KIRKSEY, JUANITA CERISE (ALC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:CERISE
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 HUEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2632
Mailing Address - Country:US
Mailing Address - Phone:205-436-8093
Mailing Address - Fax:205-449-5071
Practice Address - Street 1:1289 HUEYTOWN RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2632
Practice Address - Country:US
Practice Address - Phone:205-436-8093
Practice Address - Fax:205-449-5071
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3892A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor