Provider Demographics
NPI:1083402838
Name:HART, JANIS LYNN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:LYNN
Last Name:HART
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SOUTHBRIDGE PKWY STE 650
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1317
Mailing Address - Country:US
Mailing Address - Phone:256-466-3303
Mailing Address - Fax:
Practice Address - Street 1:2307 ANDERSON DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1003
Practice Address - Country:US
Practice Address - Phone:256-466-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6199C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty