Provider Demographics
NPI:1639575426
Name:ALABAMA FAMILY RESOURCE CENTER, PC
Entity Type:Organization
Organization Name:ALABAMA FAMILY RESOURCE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:TEAL
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-389-2079
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:THORSBY
Mailing Address - State:AL
Mailing Address - Zip Code:35171-0055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1881 COUNTY ROAD 627
Practice Address - Street 2:
Practice Address - City:THORSBY
Practice Address - State:AL
Practice Address - Zip Code:35171-8151
Practice Address - Country:US
Practice Address - Phone:205-389-2079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty