Provider Demographics
NPI:1962140954
Name:SHELBY, ARIEL R (LICSW)
Entity type:Individual
Prefix:MISS
First Name:ARIEL
Middle Name:R
Last Name:SHELBY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-2522
Mailing Address - Country:US
Mailing Address - Phone:205-380-9455
Mailing Address - Fax:205-380-9459
Practice Address - Street 1:2152 OLD SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-4005
Practice Address - Country:US
Practice Address - Phone:205-838-6000
Practice Address - Fax:205-838-6922
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4964C1041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000007Medicaid