Healthcare Provider Details

I. General information

NPI: 1609781160
Provider Name (Legal Business Name): MADISON MARIE MOODY ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S COURT ST
FLORENCE AL
35630-6111
US

IV. Provider business mailing address

234 KELLER PARK BLVD
TUSCUMBIA AL
35674-1417
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-6963
  • Fax: 256-765-7776
Mailing address:
  • Phone: 256-381-6963
  • Fax: 256-381-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC06005
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: