Healthcare Provider Details

I. General information

NPI: 1316082035
Provider Name (Legal Business Name): CHRISTOPHER M. SMITH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316
US

IV. Provider business mailing address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316
US

V. Phone/Fax

Practice location:
  • Phone: 334-237-3838
  • Fax: 334-489-4606
Mailing address:
  • Phone: 334-237-3838
  • Fax: 334-489-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1851
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1851
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: