Provider Demographics
NPI:1801510771
Name:MARCANO, MIRANDA KING (ALC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KING
Last Name:MARCANO
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:KING
Other - Last Name:MARCANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALC
Mailing Address - Street 1:5163 COLONIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-3203
Mailing Address - Country:US
Mailing Address - Phone:205-757-6441
Mailing Address - Fax:
Practice Address - Street 1:1063 NARROWS WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8681
Practice Address - Country:US
Practice Address - Phone:205-757-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health