Provider Demographics
NPI:1396542601
Name:SAMUEL, BRITTINEY (ALC)
Entity type:Individual
Prefix:
First Name:BRITTINEY
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 ABERLADY PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6090
Mailing Address - Country:US
Mailing Address - Phone:205-616-7772
Mailing Address - Fax:
Practice Address - Street 1:404 15TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1845
Practice Address - Country:US
Practice Address - Phone:205-777-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health