Provider Demographics
NPI:1639347818
Name:SOUTHEAST ALABAMA COUNSELING & BEHAVIORAL SPECIALIST
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA COUNSELING & BEHAVIORAL SPECIALIST
Other - Org Name:SEAL COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-699-8743
Mailing Address - Street 1:407 HONEYSUCKLE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305
Mailing Address - Country:US
Mailing Address - Phone:334-699-8743
Mailing Address - Fax:334-699-8748
Practice Address - Street 1:407 HONEYSUCKLE RD STE 207
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305
Practice Address - Country:US
Practice Address - Phone:334-699-8743
Practice Address - Fax:334-699-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children