Provider Demographics
NPI:1528024023
Name:GUTHRIE, BEVERLY DIANNE (LCSW, PIP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:DIANNE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:DIANNE
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSWAC
Mailing Address - Street 1:12722 SANFORD LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-7210
Mailing Address - Country:US
Mailing Address - Phone:205-752-2866
Mailing Address - Fax:
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-554-2000
Practice Address - Fax:205-554-3556
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1408C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical