Provider Demographics
NPI:1336908805
Name:LIPHAM, WENDY L (MS, ALC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:LIPHAM
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 REGENTS DR S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3255
Mailing Address - Country:US
Mailing Address - Phone:251-709-8100
Mailing Address - Fax:
Practice Address - Street 1:5803 REGENTS DR S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3255
Practice Address - Country:US
Practice Address - Phone:251-709-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health