Provider Demographics
NPI:1194578872
Name:MORRISON-FOREST, VIVIAN KIMBERLEY (DAC)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:KIMBERLEY
Last Name:MORRISON-FOREST
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:AUTAUGAVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36003-0534
Mailing Address - Country:US
Mailing Address - Phone:202-215-6389
Mailing Address - Fax:
Practice Address - Street 1:509 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5749
Practice Address - Country:US
Practice Address - Phone:202-215-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171100000X
MDU03089171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker