Provider Demographics
NPI:1225466295
Name:SOUTHEAST ALABAMA HUMAN DEVELOPMENT COUNCIL
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA HUMAN DEVELOPMENT COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-585-0250
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36310-0565
Mailing Address - Country:US
Mailing Address - Phone:334-585-0250
Mailing Address - Fax:334-585-0675
Practice Address - Street 1:1057 COUNTY ROAD 53
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310-6443
Practice Address - Country:US
Practice Address - Phone:334-585-0250
Practice Address - Fax:334-585-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health