Provider Demographics
NPI:1720850332
Name:WITHERS, XZAVIER JASHAWN
Entity type:Individual
Prefix:
First Name:XZAVIER
Middle Name:JASHAWN
Last Name:WITHERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-1652
Mailing Address - Country:US
Mailing Address - Phone:406-781-0421
Mailing Address - Fax:
Practice Address - Street 1:935 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-1652
Practice Address - Country:US
Practice Address - Phone:406-781-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB1016537106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician