Provider Demographics
NPI:1780815423
Name:MCGINNIS TOLBERT, CLARICE (LPC)
Entity Type:Individual
Prefix:
First Name:CLARICE
Middle Name:
Last Name:MCGINNIS TOLBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310815
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35231-0815
Mailing Address - Country:US
Mailing Address - Phone:205-223-9843
Mailing Address - Fax:205-798-2604
Practice Address - Street 1:6101 DR MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-2599
Practice Address - Country:US
Practice Address - Phone:205-223-9843
Practice Address - Fax:205-798-2604
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL377OtherSUPERVISING COUNSELOR
AL1120OtherLICENSED PROFESSIONAL COUNSELOR