Provider Demographics
NPI:1053513374
Name:BRISTOW, PATRICIA A (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 TAHOE CIR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9628
Mailing Address - Country:US
Mailing Address - Phone:256-655-7577
Mailing Address - Fax:
Practice Address - Street 1:607 MCCULLOUGH AVE NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6342
Practice Address - Country:US
Practice Address - Phone:256-655-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1862C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical