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DR. ALLEN R STATA PHD, LCSW (PIP) ACSW

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1861934705

Individual Registrant:
DR. ALLEN R STATA PHD, LCSW (PIP) ACSW
Gender: M
Not Sole Proprietor

Location and contact information for practice:
104 EDWARDS DRIVE  MARION, AL 36756 US
Tel: 334-815-2100  Fax: 334-683-4114

Contact information for business:
1017 MEDICAL CENTER PARKWAY  SELMA, AL 36701 US
Tel: 334-875-2100  Fax: 334-418-6540

Registration Information:
NPI: 1861934705
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
AL2235C

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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