Provider Demographics
NPI:1831189703
Name:GARDNER, SYDNEY H (PSYD)
Entity type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:H
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 MAGNOLIA CURV
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2011
Mailing Address - Country:US
Mailing Address - Phone:334-233-3080
Mailing Address - Fax:334-356-6605
Practice Address - Street 1:2911 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2648
Practice Address - Country:US
Practice Address - Phone:334-262-7787
Practice Address - Fax:334-262-7795
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1354OtherAL BOARD OF EXAMINERS IN