Provider Demographics
NPI:1477100634
Name:BORN AGAIN COUNSELING
Entity Type:Organization
Organization Name:BORN AGAIN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-233-7436
Mailing Address - Street 1:PO BOX 230426
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0426
Mailing Address - Country:US
Mailing Address - Phone:334-233-7436
Mailing Address - Fax:334-647-2727
Practice Address - Street 1:822 PLANTATION WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3611
Practice Address - Country:US
Practice Address - Phone:334-954-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health