Healthcare Provider Details

I. General information

NPI: 1083428213
Provider Name (Legal Business Name): ANNETTE SHERMAN MATTINGLY ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE THERESA SHERMAN ALC

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 OFFICE PARK DR STE 290
MOUNTAIN BRK AL
35223-3100
US

IV. Provider business mailing address

402 OFFICE PARK DR STE 290
MOUNTAIN BRK AL
35223-3100
US

V. Phone/Fax

Practice location:
  • Phone: 205-918-6161
  • Fax:
Mailing address:
  • Phone: 205-538-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC05190
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: