Provider Demographics
NPI:1730050014
Name:STURDIVANT, MICHAEL JEROME
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:STURDIVANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35808-3007
Mailing Address - Country:US
Mailing Address - Phone:256-203-3883
Mailing Address - Fax:
Practice Address - Street 1:3311 BOB WALLACE AVE SW STE 205
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4064
Practice Address - Country:US
Practice Address - Phone:256-690-3943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YP2500X, 101YM0800X, 103TP2701X, 106H00000X, 133N00000X, 133VN1201X, 171400000X, 173C00000X, 174200000X, 174H00000X, 175L00000X, 225700000X, 261QI0500X, 320800000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No171400000XOther Service ProvidersHealth & Wellness Coach
No173C00000XOther Service ProvidersReflexologist
No174200000XOther Service ProvidersMeals
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness