Provider Demographics
NPI:1871086850
Name:HOWARD, TINA SULLINS (MA, ALC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:SULLINS
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MA, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 SNOW RD N STE 1C
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-9713
Mailing Address - Country:US
Mailing Address - Phone:251-622-6838
Mailing Address - Fax:251-650-1726
Practice Address - Street 1:879 SNOW RD N STE 1C
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9713
Practice Address - Country:US
Practice Address - Phone:251-622-3080
Practice Address - Fax:251-650-1726
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1687A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC1687AOtherABEC