Healthcare Provider Details

I. General information

NPI: 1184537979
Provider Name (Legal Business Name): ALIVIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 FOX RUN E
QUINCY IL
62301-6254
US

IV. Provider business mailing address

1798 E COUNTY ROAD 1540 N
CARTHAGE IL
62321-3448
US

V. Phone/Fax

Practice location:
  • Phone: 814-230-0024
  • Fax:
Mailing address:
  • Phone: 217-440-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: