Most Relevant Information
Provider Data
| NPI Number: | 1003402694 |
| Provider Name: | SHANNON COLEMAN HUMPHRIES ALC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | C2358A |
Most Important Dates
| Enumeration Date: | 12/17/2020 |
| Last Updated: | 12/17/2020 |
Provider Practice Location
1820 GLYNWOOD DR STE B
PRATTVILLE
AL
360665533
Practice Location Phone/Fax
| Phone: | 3343582455 |
| Fax: |
Provider Mailing Location
1820 GLYNWOOD DR STE B
PRATTVILLE
AL
360665533
Provider Mailing Phone/Fax
| Phone: | 3343582455 |
| Fax: |