Provider Demographics
NPI:1851134316
Name:DALE, JILLIAN (ALC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 TURF DR
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-3911
Mailing Address - Country:US
Mailing Address - Phone:205-212-0202
Mailing Address - Fax:
Practice Address - Street 1:2441 INTERNATIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-4252
Practice Address - Country:US
Practice Address - Phone:205-813-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health