Provider Demographics
NPI:1740567890
Name:EXTENDED FAMILY INC
Entity Type:Organization
Organization Name:EXTENDED FAMILY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVORIS
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:205-910-8762
Mailing Address - Street 1:2300 CENTER WAY S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-6728
Mailing Address - Country:US
Mailing Address - Phone:205-910-8762
Mailing Address - Fax:205-777-4023
Practice Address - Street 1:2300 CENTER WAY S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-6728
Practice Address - Country:US
Practice Address - Phone:205-910-8762
Practice Address - Fax:205-777-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health