Provider Demographics
NPI:1609965185
Name:MOON, POPPY KIMBERLY (PHD, NCC, LPC)
Entity Type:Individual
Prefix:DR
First Name:POPPY
Middle Name:KIMBERLY
Last Name:MOON
Suffix:
Gender:F
Credentials:PHD, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 HELEN KELLER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2963
Mailing Address - Country:US
Mailing Address - Phone:205-554-0866
Mailing Address - Fax:205-554-0279
Practice Address - Street 1:661 HELEN KELLER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2963
Practice Address - Country:US
Practice Address - Phone:205-554-0866
Practice Address - Fax:205-554-0279
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC #2250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional