Healthcare Provider Details

I. General information

NPI: 1841154275
Provider Name (Legal Business Name): ICU SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 STUDENT CENTER CIR U3715
MOBILE AL
36688-0001
US

IV. Provider business mailing address

350 STUDENT CENTER CIR U3715
MOBILE AL
36688-0001
US

V. Phone/Fax

Practice location:
  • Phone: 251-545-9659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEMETRIUS SMITH
Title or Position: OWNER
Credential: LPC, NCC
Phone: 251-545-9659