Provider Demographics
NPI:1396127924
Name:COUSINS, BETTY ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:ANN
Last Name:COUSINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CCB FL 4
Mailing Address - Street 2:1720 2ND AVE. SOUTH
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2050
Mailing Address - Country:US
Mailing Address - Phone:205-934-3478
Mailing Address - Fax:205-975-8950
Practice Address - Street 1:CCB FL 4
Practice Address - Street 2:1720 2ND AVE. SOUTH
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-2050
Practice Address - Country:US
Practice Address - Phone:205-934-3478
Practice Address - Fax:205-975-8950
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3835C1041C0700X
AL2428G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical