Provider Demographics
NPI:1376362194
Name:UNDERWOOD, BYANCA (ALC, NCC)
Entity type:Individual
Prefix:
First Name:BYANCA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 LONGVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3644
Mailing Address - Country:US
Mailing Address - Phone:205-238-0644
Mailing Address - Fax:
Practice Address - Street 1:5690 LONGVIEW TRL
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-3644
Practice Address - Country:US
Practice Address - Phone:205-238-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health