Provider Demographics
NPI:1912654229
Name:GIVHAN, ANTONIO FREQUAZ (MS, ALC, ECMH-E)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:FREQUAZ
Last Name:GIVHAN
Suffix:
Gender:M
Credentials:MS, ALC, ECMH-E
Other - Prefix:MR
Other - First Name:ANTONIO
Other - Middle Name:FREQUAZ
Other - Last Name:GIVHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ALC, ECMH-E
Mailing Address - Street 1:6217 WYNFREY PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4813
Mailing Address - Country:US
Mailing Address - Phone:334-819-6508
Mailing Address - Fax:
Practice Address - Street 1:6217 WYNFREY PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4813
Practice Address - Country:US
Practice Address - Phone:334-819-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3995A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor