Provider Demographics
NPI:1902398274
Name:LONDON, TUNISIA (LICSW-S, PIP)
Entity Type:Individual
Prefix:
First Name:TUNISIA
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:LICSW-S, PIP
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, PIP
Mailing Address - Street 1:34124 BURWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-7301
Mailing Address - Country:US
Mailing Address - Phone:251-401-5602
Mailing Address - Fax:251-340-2596
Practice Address - Street 1:9532 WYNLAKES PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8515
Practice Address - Country:US
Practice Address - Phone:334-270-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW194491041C0700X
AL1421-4097C1041C0700X, 1041C0700X
VA09040138981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical