Provider Demographics
NPI:1689019366
Name:DELOACH, TIMOTHY D (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:D
Last Name:DELOACH
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 SLEDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3000
Mailing Address - Country:US
Mailing Address - Phone:251-473-3410
Mailing Address - Fax:251-476-4454
Practice Address - Street 1:22765 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3499
Practice Address - Country:US
Practice Address - Phone:251-473-3410
Practice Address - Fax:251-476-4454
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC02224101YM0800X
AL2224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health