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Provider Information for 1043265408


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NATALIA KOULICHOVA LPC


Sex: Female

NPI: 1043265408
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1043265408
Enumeration Date2006-05-24
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 2868 ACTON ROAD
BIRMINGHAM, AL 35243
United States

Phone: 205-968-8360 | Fax:205-968-8373
 
Primary Practice Address 2868 ACTON ROAD
BIRMINGHAM, AL 35243
United States

Phone: 205-968-8360 | Fax:205-968-8373
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)AL51519497BCBS
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 2084P0800X - Psychiatry & Neurology - PsychiatryAL2012