=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023626645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY D SMITH LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2020
-----------------------------------------------------
Last Update Date | 07/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9532 WYNLAKES PL
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-8515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-270-2181
-----------------------------------------------------
Fax | 334-270-5805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10100 ELIDA RD
-----------------------------------------------------
City | DELPHOS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45833-9056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-695-8010
-----------------------------------------------------
Fax | 702-685-0004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 3046G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------