Provider Demographics
NPI:1487898284
Name:NUNNELLY, ANGELA JO (ALC, MS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:NUNNELLY
Suffix:
Gender:F
Credentials:ALC, MS
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:JO
Other - Last Name:JAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:307 S 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4259
Mailing Address - Country:US
Mailing Address - Phone:256-393-0705
Mailing Address - Fax:205-238-6663
Practice Address - Street 1:307 S 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4259
Practice Address - Country:US
Practice Address - Phone:256-393-0705
Practice Address - Fax:205-238-6663
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ALALC01278101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health