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General NPI Number Information
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NPI Number | 1730050014
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Entity Type | Individual
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Provider Name | MR. MICHAEL JEROME STURDIVANT
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Gender | Male
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 3311 BOB WALLACE AVE SW STE 205
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City | HUNTSVILLE
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State | AL
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Zip | 35805-4064
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Country | US
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Telephone | 256-690-3943
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 MARKET ST STE 100
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City | HUNTSVILLE
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State | AL
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Zip | 35808-3007
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Country | US
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Telephone | 256-203-3883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State | AL
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Taxonomy #6
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State | AL
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Taxonomy #7
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | AL
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Taxonomy #8
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State | AL
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Taxonomy #9
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State | AL
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Taxonomy #10
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | AL
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Taxonomy #11
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State | AL
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Taxonomy #12
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | AL
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Taxonomy #13
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State | AL
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Taxonomy #14
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | AL
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Taxonomy #15
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State | AL
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