Provider Demographics
NPI:1477179190
Name:PUGH, DONICA (ALC)
Entity Type:Individual
Prefix:MS
First Name:DONICA
Middle Name:
Last Name:PUGH
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 1:266 GADSDEN HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-1022
Mailing Address - Country:US
Mailing Address - Phone:205-994-4563
Mailing Address - Fax:
Practice Address - Street 1:266 GADSDEN HWY STE 102
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-1022
Practice Address - Country:US
Practice Address - Phone:205-994-4563
Practice Address - Fax:205-206-7131
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health