Provider Demographics
NPI:1558466854
Name:PHOHA, RAJLAXSHMI (PHD)
Entity Type:Individual
Prefix:
First Name:RAJLAXSHMI
Middle Name:
Last Name:PHOHA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1250
Mailing Address - Country:US
Mailing Address - Phone:205-759-0799
Mailing Address - Fax:205-759-0845
Practice Address - Street 1:200 UNIVERSITY BLVD
Practice Address - Street 2:BRYCE HOSPITAL
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1250
Practice Address - Country:US
Practice Address - Phone:205-759-0799
Practice Address - Fax:205-759-0845
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
680013658OtherR/R GROUP
AL051550210Medicaid