Category: | Health, |
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Address: | 4000 Southlake Park #150, Birmingham, AL 35244, USA |
Postal code: | 35244 |
Phone: | (205) 988-4350 |
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Koinonia Counseling Services LLC 265 Riverchase Pkwy East, Suite 101 Birmingham, AL 35244 Daytime Phone: (205) 988-4350 Fax: (205) 988-4351 Business Phone: (205) 617-8313 Insurance and Financial Agreement IMPORTANT INFORMATION AND CLIENT CONSENT:
Koinonia Counseling Services, LLC 4000 Southlake Park, Suite 150 Birmingham, AL 35244 (205) 988-4350 Fax: (205) 988-4351 Business Phone: (205) 617-8313 Middle Name: City: Last Name: State: Work Phone #: Zip: Cell Phone #: Age: Social Security #: Marital Status: Relationship to Patient: Living Arrangement: Relationship to Patient: Gender: