Provider Demographics
NPI:1508260589
Name:FAVELA, BEATRIZ (LCISW)
Entity Type:Individual
Prefix:MS
First Name:BEATRIZ
Middle Name:
Last Name:FAVELA
Suffix:
Gender:F
Credentials:LCISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CAMPHOR AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2819
Mailing Address - Country:US
Mailing Address - Phone:251-990-4327
Mailing Address - Fax:
Practice Address - Street 1:201 E CAMPHOR AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2819
Practice Address - Country:US
Practice Address - Phone:251-990-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM06360104100000X
AL5369-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker