Provider Demographics
NPI:1184229460
Name:MCDANIEL, KEZZIAH FAITH (LPC-S)
Entity Type:Individual
Prefix:DR
First Name:KEZZIAH
Middle Name:FAITH
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1157
Mailing Address - Country:US
Mailing Address - Phone:205-253-8216
Mailing Address - Fax:
Practice Address - Street 1:1300 AVENUE R
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1157
Practice Address - Country:US
Practice Address - Phone:205-253-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty