Provider Demographics
NPI:1053931204
Name:ELMORE, TANDREA SHIRONE (MS,ALC,NCC)
Entity type:Individual
Prefix:
First Name:TANDREA
Middle Name:SHIRONE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:MS,ALC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 CROSSLAND LOOP STE 104
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8522
Mailing Address - Country:US
Mailing Address - Phone:334-398-0668
Mailing Address - Fax:
Practice Address - Street 1:8436 CROSSLAND LOOP STE 104
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8522
Practice Address - Country:US
Practice Address - Phone:334-398-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3304A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty