Provider Demographics
NPI:1184073652
Name:BELL, WILLIE III (ALC)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:BELL
Suffix:III
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8089 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9530
Mailing Address - Country:US
Mailing Address - Phone:256-325-0424
Mailing Address - Fax:
Practice Address - Street 1:8089 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9530
Practice Address - Country:US
Practice Address - Phone:256-325-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2437A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor