Provider Demographics
NPI:1659706216
Name:ANTONIO PSYCHOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:ANTONIO PSYCHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:205-612-0707
Mailing Address - Street 1:3516 VANN RD
Mailing Address - Street 2:SUITE 104-B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3275
Mailing Address - Country:US
Mailing Address - Phone:205-612-0707
Mailing Address - Fax:
Practice Address - Street 1:3516 VANN RD
Practice Address - Street 2:SUITE 104-B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3275
Practice Address - Country:US
Practice Address - Phone:205-612-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty