Provider Demographics
NPI:1154689164
Name:BIRMINGHAM FAMILY COUNSELING AND MEDIATION CENTER
Entity type:Organization
Organization Name:BIRMINGHAM FAMILY COUNSELING AND MEDIATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MIXON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:S-LPC
Authorized Official - Phone:205-447-0585
Mailing Address - Street 1:2329 1ST AVE N
Mailing Address - Street 2:LOFT 304
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-4332
Mailing Address - Country:US
Mailing Address - Phone:205-447-0585
Mailing Address - Fax:205-801-5169
Practice Address - Street 1:2329 1ST AVE N
Practice Address - Street 2:LOFT 304
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-4332
Practice Address - Country:US
Practice Address - Phone:205-447-0585
Practice Address - Fax:205-801-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1796251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health