Healthcare Provider Details

I. General information

NPI: 1114856036
Provider Name (Legal Business Name): FOUNDATIONS NUTRITION & LIFESTYLE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11156 COUNTY LINE RD
MADISON AL
35756-5402
US

IV. Provider business mailing address

132 BAYBERRY LN
MADISON AL
35758-6013
US

V. Phone/Fax

Practice location:
  • Phone: 256-696-0406
  • Fax:
Mailing address:
  • Phone: 256-696-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY K MCCORMACK
Title or Position: DIETITIAN
Credential: MS, RD, LDN
Phone: 256-696-0406