Provider Demographics
NPI:1912236779
Name:WINDS OF CHANGE PSYCHOLOGICAL SERVICES OF MOBILE
Entity Type:Organization
Organization Name:WINDS OF CHANGE PSYCHOLOGICAL SERVICES OF MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:251-824-8602
Mailing Address - Street 1:15360 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CODEN
Mailing Address - State:AL
Mailing Address - Zip Code:36523-3206
Mailing Address - Country:US
Mailing Address - Phone:251-824-8602
Mailing Address - Fax:
Practice Address - Street 1:6341 PICCADILLY SQUARE DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5103
Practice Address - Country:US
Practice Address - Phone:251-343-5300
Practice Address - Fax:251-343-6613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDS OF CHANGE PSYCHOLOGICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty