Basic Information
| Provider Information | |||||||||
| NPI: | 1639469687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COODY | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSW, MPH, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5303 VAUGHN RD | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361161120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343860343 | ||||||||
| FaxNumber: | 3343860382 | ||||||||
| Practice Location | |||||||||
| Address1: | 5303 VAUGHN RD | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361161120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343860343 | ||||||||
| FaxNumber: | 3343860382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2064C | AL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.