Provider Demographics
NPI:1487868501
Name:CALLOWAY, IANTHA
Entity Type:Individual
Prefix:
First Name:IANTHA
Middle Name:
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4092 MEMORIAL PKWY SW STE 205
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-4367
Mailing Address - Country:US
Mailing Address - Phone:253-551-1610
Mailing Address - Fax:256-551-0722
Practice Address - Street 1:4092 MEMORIAL PKWY SW STE 205
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4367
Practice Address - Country:US
Practice Address - Phone:256-551-1610
Practice Address - Fax:256-551-0722
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health