Provider Demographics
NPI:1366608408
Name:DEVINE, JACQUELINE MOORE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MOORE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:M
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4057 S SHADES CREST RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-6727
Mailing Address - Country:US
Mailing Address - Phone:205-876-5721
Mailing Address - Fax:
Practice Address - Street 1:1109 TOWNHOUSE RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-4012
Practice Address - Country:US
Practice Address - Phone:205-200-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional