Provider Demographics
NPI:1780684746
Name:GRAMLING, PHILLIP W (LPC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:W
Last Name:GRAMLING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:WAYNE
Other - Last Name:GRAMLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:118 OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5814
Mailing Address - Country:US
Mailing Address - Phone:256-393-1888
Mailing Address - Fax:
Practice Address - Street 1:105 CHURCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6242
Practice Address - Country:US
Practice Address - Phone:256-393-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2369OtherLPC
AL2369OtherLPC