Provider Information for 1730355017
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
G TEAL DICK M.Div. LPC-S
Sex: Male
NPI: 1730355017
Last Updated: 2014-10-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1730355017 | ||||||||||||
| Enumeration Date | 2008-05-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | P.O. BOX 55 THORSBY, AL 35171-3428 United States Phone: 205-389-2079 | Fax: | ||||||||||||
| Primary Practice Address | 1881 COUNTY ROAD 627 THORSBY, AL 35171-8151 United States Phone: 205-389-2079 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|