Provider Demographics
NPI:1629637749
Name:PICKENS, GIJUAN YVETTE
Entity Type:Individual
Prefix:
First Name:GIJUAN
Middle Name:YVETTE
Last Name:PICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 CAHABA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2602
Mailing Address - Country:US
Mailing Address - Phone:205-847-0779
Mailing Address - Fax:
Practice Address - Street 1:2233 CAHABA VALLEY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2602
Practice Address - Country:US
Practice Address - Phone:205-847-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT1989176106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician