Provider Demographics
NPI:1174841845
Name:CONNER, CAROL YVONNE (BS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:YVONNE
Last Name:CONNER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 WATERFALL LN
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2935
Mailing Address - Country:US
Mailing Address - Phone:205-454-0492
Mailing Address - Fax:205-633-2773
Practice Address - Street 1:627 29TH ST APT B2
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7194
Practice Address - Country:US
Practice Address - Phone:205-454-0492
Practice Address - Fax:205-633-2773
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health