Provider Demographics
NPI:1215561162
Name:FAVOR, ITHACA L (LPC)
Entity type:Individual
Prefix:
First Name:ITHACA
Middle Name:L
Last Name:FAVOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ITHACA
Other - Middle Name:A
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALC
Mailing Address - Street 1:6617 CONCORD MEWS
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-5293
Mailing Address - Country:US
Mailing Address - Phone:334-604-3932
Mailing Address - Fax:
Practice Address - Street 1:882 PLANTATION WAY STE E
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2217
Practice Address - Country:US
Practice Address - Phone:334-604-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3455A101YM0800X
ALLPC04612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health