Provider Demographics
NPI:1972797843
Name:DYER, ALBERT JAMES I (PASTOR)
Entity type:Individual
Prefix:PROF
First Name:ALBERT
Middle Name:JAMES
Last Name:DYER
Suffix:I
Gender:M
Credentials:PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4008
Mailing Address - Country:US
Mailing Address - Phone:318-861-4603
Mailing Address - Fax:
Practice Address - Street 1:1226 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4008
Practice Address - Country:US
Practice Address - Phone:318-861-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral