Provider Demographics
NPI:1346958881
Name:PHILLIPS, LORI SPEAKMAN (ALC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SPEAKMAN
Last Name:PHILLIPS
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 1:5013 BUGGY LN
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36206-1542
Mailing Address - Country:US
Mailing Address - Phone:205-520-3670
Mailing Address - Fax:
Practice Address - Street 1:1117 22ND ST S STE 208
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2813
Practice Address - Country:US
Practice Address - Phone:205-319-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health