Provider Demographics
NPI:1386253896
Name:BISHOP, CHARLECE
Entity type:Individual
Prefix:
First Name:CHARLECE
Middle Name:
Last Name:BISHOP
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 1:4628 MONTEVALLO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3100
Mailing Address - Country:US
Mailing Address - Phone:205-451-9456
Mailing Address - Fax:
Practice Address - Street 1:4628 MONTEVALLO RD STE 101
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-3100
Practice Address - Country:US
Practice Address - Phone:205-451-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health