Healthcare Provider Details

I. General information

NPI: 1366930596
Provider Name (Legal Business Name): ALTRAVEISE MELVINA SMITH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SW 12TH AVE
POMPANO BEACH FL
33069-3502
US

IV. Provider business mailing address

380 SW 12TH AVE
POMPANO BEACH FL
33069-3502
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-9774
  • Fax: 954-782-3843
Mailing address:
  • Phone: 954-782-9774
  • Fax: 954-782-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: