Provider Demographics
NPI:1588302863
Name:NORTHEAST ALABAMA CLINICAL SERVICES
Entity type:Organization
Organization Name:NORTHEAST ALABAMA CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ALC, NCC
Authorized Official - Phone:256-273-9369
Mailing Address - Street 1:68 MADIE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AL
Mailing Address - Zip Code:35096-5759
Mailing Address - Country:US
Mailing Address - Phone:205-362-7124
Mailing Address - Fax:
Practice Address - Street 1:381 QUILL AVE NW APT 61
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-1460
Practice Address - Country:US
Practice Address - Phone:256-273-9369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty