Provider Demographics
NPI:1225701899
Name:ENGLE, KAITLYN BROOKE (ALC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:BROOKE
Last Name:ENGLE
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 1:165 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35953-5768
Mailing Address - Country:US
Mailing Address - Phone:256-453-7532
Mailing Address - Fax:
Practice Address - Street 1:753 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4138
Practice Address - Country:US
Practice Address - Phone:256-673-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3835A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health