Provider Demographics
NPI:1316625437
Name:PICKENS, MIKALA (ALC)
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:PICKENS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 TERESA AVE
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-3055
Mailing Address - Country:US
Mailing Address - Phone:205-568-4810
Mailing Address - Fax:
Practice Address - Street 1:3061 TERESA AVE
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-3055
Practice Address - Country:US
Practice Address - Phone:205-205-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health