Provider Demographics
NPI:1154785996
Name:ESSARY, MICHELLE DOUGLASS (MA, LPC, BCN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOUGLASS
Last Name:ESSARY
Suffix:
Gender:F
Credentials:MA, LPC, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 STADIUM TRACE PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4525
Mailing Address - Country:US
Mailing Address - Phone:205-201-0661
Mailing Address - Fax:
Practice Address - Street 1:5330 STADIUM TRACE PKWY STE 310
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4525
Practice Address - Country:US
Practice Address - Phone:205-490-6983
Practice Address - Fax:205-490-6984
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012901101Y00000X
AL4284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor