Provider Demographics
NPI:1306266895
Name:DANTZLER, CATRECE
Entity type:Individual
Prefix:
First Name:CATRECE
Middle Name:
Last Name:DANTZLER
Suffix:
Gender:F
Credentials:
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 231402
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-1402
Mailing Address - Country:US
Mailing Address - Phone:334-467-4992
Mailing Address - Fax:334-396-5896
Practice Address - Street 1:4560 WOODLEY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-4734
Practice Address - Country:US
Practice Address - Phone:334-467-4992
Practice Address - Fax:334-396-5896
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3252101Y00000X
AL397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist