Richard    Hamrick   
Contract Details
Facility name
Provider ID
P000000001
NPI
1093280182
Tax ID
832394149
Effective Date
1/30/2024
Last Updated
2/5/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
3776 Sullivan Street Suite D
Madison, AL 35758
United States
Phone
256-325-0467 (Phone)
Billing Details
Address
3776 Sullivan Street
Suite D
Madison, AL 35758
Billing Phone
256-325-0467
Specialty Type
Counselor - Professional
Website
Visit Website
Map
Address