Provider Demographics
NPI:1457553190
Name:PAYNE, PERRY LAMAR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:LAMAR
Last Name:PAYNE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 BUTTERCUP CIR
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-2675
Mailing Address - Country:US
Mailing Address - Phone:205-640-4785
Mailing Address - Fax:205-594-2280
Practice Address - Street 1:3016 BUTTERCUP CIR
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-2675
Practice Address - Country:US
Practice Address - Phone:205-640-4785
Practice Address - Fax:205-594-2280
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2067C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical