Provider Demographics
NPI:1831551621
Name:BODIFORD, REBECCA SHEREE (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SHEREE
Last Name:BODIFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 UNIVERSITY CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8016
Mailing Address - Country:US
Mailing Address - Phone:334-239-2622
Mailing Address - Fax:334-625-7602
Practice Address - Street 1:7125 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8016
Practice Address - Country:US
Practice Address - Phone:334-239-2622
Practice Address - Fax:334-625-7602
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2004103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical