Provider Demographics
NPI:1568560696
Name:KIDNEY COUNSELOR,LLC
Entity Type:Organization
Organization Name:KIDNEY COUNSELOR,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:IX
Authorized Official - Credentials:RD,LD
Authorized Official - Phone:334-202-4342
Mailing Address - Street 1:207 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4105
Mailing Address - Country:US
Mailing Address - Phone:334-202-4342
Mailing Address - Fax:334-277-8929
Practice Address - Street 1:4163 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2881
Practice Address - Country:US
Practice Address - Phone:334-396-5570
Practice Address - Fax:334-396-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL270261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center