Full Name | The Centre |
---|---|
Speciality | Counselor - Mental Health |
Location | 1290 Main St Ste E, Daphne, Alabama |
Authorized Official Name and Position | Robert Edwin Colclough (DIRECTOR) |
Authorized Official Contact | 2516250118 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
The Centre 1290 Main St Ste E Daphne AL 36526-8624 Ph: (251) 625-0118 | The Centre 1290 Main St Ste E Daphne AL 36526-8624 Ph: (251) 625-0118 |
NPI Number | 1104073592 |
---|---|
Provider Enumeration Date | 08/27/2008 |
Last Update Date | 09/16/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104073592 | NPI | - | NPPES |
515 92982 | Other | AL | BLUE CROSS |
515 92986 | Other | AL | BLUE CROSS ROBERT COLCLOUGH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | LPC 111 AL (Alabama) | Primary |
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