Healthcare Provider Details

I. General information

NPI: 1245558444
Provider Name (Legal Business Name): NICOLE CRAFT SMITH M.S. THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HORNADY DR
MONROEVILLE AL
36460-8658
US

IV. Provider business mailing address

766 TABERNACLE RD
MONROEVILLE AL
36460-8954
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-4837
  • Fax: 251-575-5266
Mailing address:
  • Phone: 251-765-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: