Provider Demographics
NPI:1487819561
Name:SOUTHEAST ALABAMA COUNSELING AND BEHAVIORAL SPECIALIST SERVICES, LLC
Entity type:Organization
Organization Name:SOUTHEAST ALABAMA COUNSELING AND BEHAVIORAL SPECIALIST SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ALC, EAP
Authorized Official - Phone:334-699-8743
Mailing Address - Street 1:407 HONEYSUCKLE RD
Mailing Address - Street 2:STE 207
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1227
Mailing Address - Country:US
Mailing Address - Phone:334-699-8743
Mailing Address - Fax:334-699-8748
Practice Address - Street 1:407 HONEYSUCKLE RD
Practice Address - Street 2:STE 207
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1227
Practice Address - Country:US
Practice Address - Phone:334-699-8743
Practice Address - Fax:334-699-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1155A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty