Provider Demographics
NPI:1427642404
Name:PAYNE, NANCY (LICSW, PIP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-4608
Mailing Address - Country:US
Mailing Address - Phone:205-792-2979
Mailing Address - Fax:
Practice Address - Street 1:420 28TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1089
Practice Address - Country:US
Practice Address - Phone:205-737-3720
Practice Address - Fax:205-310-9969
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0651C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty