Healthcare Provider Details

I. General information

NPI: 1811985690
Provider Name (Legal Business Name): VONCEIL CORNELIUS SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 TAYLOR CIR
MONTGOMERY AL
36117-7706
US

IV. Provider business mailing address

300 SOUTH TWINING STREET BUILDING 760
MAXWELL AFB AL
36112-6219
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-3889
  • Fax:
Mailing address:
  • Phone: 334-953-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: