Provider Demographics
NPI:1750950200
Name:LEDBETTER, MENTRAL (ALC)
Entity type:Individual
Prefix:
First Name:MENTRAL
Middle Name:
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 POWE RD
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3431
Mailing Address - Country:US
Mailing Address - Phone:334-654-1871
Mailing Address - Fax:
Practice Address - Street 1:216 2ND ST SW
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-2221
Practice Address - Country:US
Practice Address - Phone:334-654-1871
Practice Address - Fax:205-293-5516
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-20
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3433A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty