Provider Demographics
NPI:1467836700
Name:JACQUELINE M DEVINE LPC LLC
Entity Type:Organization
Organization Name:JACQUELINE M DEVINE LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-876-5721
Mailing Address - Street 1:4057 S SHADES CREST RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-6727
Mailing Address - Country:US
Mailing Address - Phone:205-200-7137
Mailing Address - Fax:205-621-8680
Practice Address - Street 1:1109 TOWNHOUSE RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-4012
Practice Address - Country:US
Practice Address - Phone:205-200-7137
Practice Address - Fax:205-621-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty