Provider Demographics
NPI:1497094882
Name:SABREE, MIKAL JAMAL (LICSW, PIP)
Entity Type:Individual
Prefix:MR
First Name:MIKAL
Middle Name:JAMAL
Last Name:SABREE
Suffix:
Gender:M
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240912
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0912
Mailing Address - Country:US
Mailing Address - Phone:334-318-1584
Mailing Address - Fax:334-593-4652
Practice Address - Street 1:4131 CARMICHAEL RD STE 9
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2801
Practice Address - Country:US
Practice Address - Phone:334-318-1584
Practice Address - Fax:334-593-4652
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2962G104100000X
AL3776C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I808816Medicaid