Provider Demographics
NPI:1164631040
Name:SANTOS, JOANNE M (LGSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 YVONNE DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-3574
Mailing Address - Country:US
Mailing Address - Phone:334-393-9928
Mailing Address - Fax:
Practice Address - Street 1:19815 BAY BRANCH RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-9234
Practice Address - Country:US
Practice Address - Phone:334-222-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1239G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker