Provider Demographics
NPI:1215148531
Name:WELBOURNE, TONI DENISE
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:DENISE
Last Name:WELBOURNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:DENISE
Other - Last Name:WELBOURNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21379
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-1379
Mailing Address - Country:US
Mailing Address - Phone:205-247-2934
Mailing Address - Fax:
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 809
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-247-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0891G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker