Provider Demographics
NPI:1265489538
Name:GHOSTLEY, DAVID CARL (PSY, D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:GHOSTLEY
Suffix:
Gender:M
Credentials:PSY, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4310
Mailing Address - Country:US
Mailing Address - Phone:334-699-1620
Mailing Address - Fax:334-699-1649
Practice Address - Street 1:202 N BELL ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4310
Practice Address - Country:US
Practice Address - Phone:334-699-1620
Practice Address - Fax:334-699-1649
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934545Medicaid
AL051521304Medicare ID - Type Unspecified