Provider Demographics
NPI:1376567420
Name:WEST, DELISA ARLINDA (PHD)
Entity Type:Individual
Prefix:
First Name:DELISA
Middle Name:ARLINDA
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW STE 115
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1340
Mailing Address - Country:US
Mailing Address - Phone:205-453-9888
Mailing Address - Fax:205-453-0003
Practice Address - Street 1:817 PRINCETON AVE SW STE 115
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1340
Practice Address - Country:US
Practice Address - Phone:205-453-9888
Practice Address - Fax:205-453-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890012990Medicaid
AL051534516OtherBC FEDERAL EHBP
AL890012990OtherMEDICARE
AL051526133OtherBLUE CROSS