Provider Demographics
NPI:1689892291
Name:NIEMEIER, DAVID LOWELL (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LOWELL
Last Name:NIEMEIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VESTAVIA PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3750
Mailing Address - Country:US
Mailing Address - Phone:205-823-2373
Mailing Address - Fax:205-823-2378
Practice Address - Street 1:400 VESTAVIA PKWY STE 130
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3750
Practice Address - Country:US
Practice Address - Phone:205-823-2373
Practice Address - Fax:205-823-2378
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4612890103TC0700X
VA0810001021103TC0700X
NC4479103TC0700X
AL2116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7718705Medicaid
VA7718705Medicaid