Provider Demographics
NPI:1912131988
Name:BARE, VIRGINIA LEE (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:BARE
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 1:1940 HWY 33
Mailing Address - Street 2:STE A
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4887
Mailing Address - Country:US
Mailing Address - Phone:205-664-4010
Mailing Address - Fax:205-664-9928
Practice Address - Street 1:1940 HWY 33
Practice Address - Street 2:STE A
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-4887
Practice Address - Country:US
Practice Address - Phone:205-664-4010
Practice Address - Fax:205-664-9928
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical