Provider Demographics
NPI:1548584022
Name:VICKERS, CHANGELA WILLIAMS (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CHANGELA
Middle Name:WILLIAMS
Last Name:VICKERS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LILY FLAGG RD SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3066
Mailing Address - Country:US
Mailing Address - Phone:256-881-5352
Mailing Address - Fax:256-881-5355
Practice Address - Street 1:116 LILY FLAGG RD SW
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3066
Practice Address - Country:US
Practice Address - Phone:256-881-5352
Practice Address - Fax:256-881-5355
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist