Provider Demographics
NPI:1629825021
Name:SHIELDS, MICAH JOEL (MA, ALC)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:JOEL
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MA, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SHELTON RD APT 120
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1935
Mailing Address - Country:US
Mailing Address - Phone:205-706-8852
Mailing Address - Fax:
Practice Address - Street 1:7800 MADISON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3671
Practice Address - Country:US
Practice Address - Phone:256-384-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor