Timothy    Faulk    PHD
Contract Details
Relationship Builders - Counseling Services of Dothan
Facility name
Provider ID
P000009281
NPI
1902815319
Tax ID
631216107
Effective Date
12/18/2018
Last Updated
12/21/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1450 Ross Clark Circle Suite 3
Dothan, AL 36301
United States
County
Houston
Phone
3347942113 (Phone)
Billing Details
Address
1450 Ross Clark Circle
Suite 3
Dothan, AL 36301
Billing Phone
3347942113
Specialty Type
Counselor - Professional
Map
Address