Provider Demographics
NPI:1457014581
Name:MOORE, SHERRY VON (ALC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:VON
Last Name:MOORE
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OFFICE PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-3410
Mailing Address - Country:US
Mailing Address - Phone:205-490-6597
Mailing Address - Fax:205-905-7099
Practice Address - Street 1:400 OFFICE PARK DR STE 230
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-3410
Practice Address - Country:US
Practice Address - Phone:205-617-6638
Practice Address - Fax:205-905-7099
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2717A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL832197896Medicaid