Provider Demographics
NPI:1235874967
Name:NORTH, MYOSHI (ALC)
Entity Type:Individual
Prefix:
First Name:MYOSHI
Middle Name:
Last Name:NORTH
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 GRELOT RD STE G-1286
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3602
Mailing Address - Country:US
Mailing Address - Phone:251-272-9222
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-6425
Practice Address - Country:US
Practice Address - Phone:251-272-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC4102A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health