Provider Demographics
NPI:1548923618
Name:KNOP, ANNELIESE MARIE-DEVYLDERE (MS)
Entity type:Individual
Prefix:MRS
First Name:ANNELIESE
Middle Name:MARIE-DEVYLDERE
Last Name:KNOP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 NEPTUNE DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-1374
Mailing Address - Country:US
Mailing Address - Phone:503-302-8122
Mailing Address - Fax:
Practice Address - Street 1:3309 BOB WALLACE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4007
Practice Address - Country:US
Practice Address - Phone:256-248-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3935A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health