Provider Demographics
NPI:1669752754
Name:BIRMINGHAM ANXIETY AND TRAUMA THERAPY
Entity type:Organization
Organization Name:BIRMINGHAM ANXIETY AND TRAUMA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-807-5372
Mailing Address - Street 1:3499 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5668
Mailing Address - Country:US
Mailing Address - Phone:205-807-5372
Mailing Address - Fax:205-413-8789
Practice Address - Street 1:3499 INDEPENDENCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5668
Practice Address - Country:US
Practice Address - Phone:205-807-5372
Practice Address - Fax:205-413-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty