Healthcare Provider Details

I. General information

NPI: 1851681761
Provider Name (Legal Business Name): LAURIE LOU SMITH ED.S, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 20TH ST S SUITE 101
BIRMINGHAM AL
35205-2610
US

IV. Provider business mailing address

1530 3RD AVE S CH19-307
BIRMINGHAM AL
35294-2041
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-5471
  • Fax: 205-975-2380
Mailing address:
  • Phone: 205-934-5471
  • Fax: 205-975-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number34777
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: