Provider Demographics
NPI:1750433488
Name:ANDERSON, JAMES WILLIAM (CERTIFIED ALCOHOL DR)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CERTIFIED ALCOHOL DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OFFICE PARK CIRCLE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2538
Mailing Address - Country:US
Mailing Address - Phone:205-423-0083
Mailing Address - Fax:205-423-0058
Practice Address - Street 1:4 OFFICE PARK CIRCLE
Practice Address - Street 2:SUITE 204
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2538
Practice Address - Country:US
Practice Address - Phone:205-423-0083
Practice Address - Fax:205-423-0058
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL630101Y00000X, 101YM0800X
AL014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health