Provider Demographics
NPI:1063985562
Name:BIZZELL, CHERNELL DIANE
Entity type:Individual
Prefix:MRS
First Name:CHERNELL
Middle Name:DIANE
Last Name:BIZZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3710
Mailing Address - Country:US
Mailing Address - Phone:205-276-7279
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35226-3710
Practice Address - Country:US
Practice Address - Phone:205-276-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health