Basic Information
| Provider Information | |||||||||
| NPI: | 1124193636 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH CENTER OF NORTH CENTRAL ALABAMA INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 SOMERVILLE RD SE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356014309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563556105 | ||||||||
| FaxNumber: | 2563410747 | ||||||||
| Practice Location | |||||||||
| Address1: | 4110 US HIGHWAY 31 S | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356031644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563556105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 10/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2562607330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 51009252 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER | 590000008 | 05 | AL | MEDICAID | 51008101 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER | 330034008 | 05 | AL | MEDICAID | 330000008 | 05 | AL | MEDICAID |