Provider Demographics
NPI:1346867496
Name:ALABAMA CENTER FOR INDIVIDUAL & FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:ALABAMA CENTER FOR INDIVIDUAL & FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FEGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:256-581-4673
Mailing Address - Street 1:100 CHELLE MILL LN
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-5802
Mailing Address - Country:US
Mailing Address - Phone:773-454-0007
Mailing Address - Fax:
Practice Address - Street 1:2905 WESTCORP BLVD SW STE 213D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-6411
Practice Address - Country:US
Practice Address - Phone:256-581-4673
Practice Address - Fax:256-602-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL248819Medicaid