Provider Demographics
NPI:1396340485
Name:WINTON, RETISHA LEANN
Entity type:Individual
Prefix:
First Name:RETISHA
Middle Name:LEANN
Last Name:WINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5947 SR-269
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:AL
Mailing Address - Zip Code:35580
Mailing Address - Country:US
Mailing Address - Phone:205-686-5113
Mailing Address - Fax:
Practice Address - Street 1:5947 SR-269
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:AL
Practice Address - Zip Code:35580
Practice Address - Country:US
Practice Address - Phone:205-686-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4434G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker