Provider Demographics
NPI:1609316835
Name:LICE CLINICS OF AMERICA - GULF COAST
Entity Type:Organization
Organization Name:LICE CLINICS OF AMERICA - GULF COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED TECHNICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-660-4312
Mailing Address - Street 1:9078 MERRITT LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5614
Mailing Address - Country:US
Mailing Address - Phone:251-660-4312
Mailing Address - Fax:
Practice Address - Street 1:9078 MERRITT LN
Practice Address - Street 2:SUITE D
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5614
Practice Address - Country:US
Practice Address - Phone:251-660-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty