Provider Demographics
NPI:1912029844
Name:SOUTHEAST ALABAMA CHRISTIAN COUNSELING AND PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA CHRISTIAN COUNSELING AND PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-797-5893
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36312-0361
Mailing Address - Country:US
Mailing Address - Phone:334-797-5893
Mailing Address - Fax:
Practice Address - Street 1:305 BRUNER MILL RD
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:AL
Practice Address - Zip Code:36312-4515
Practice Address - Country:US
Practice Address - Phone:334-797-5893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1389103T00000X, 103TA0400X, 103TC1900X, 103TP2701X
103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty