MEDICARE: KIMITRIA SMITH LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	5295C	AL

General Provider Information

NPI Number	:	1902669286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMITRIA SMITH LICSW

Provider Business Mailing Address
First Line	:	5586 CHESHIRE COVE PL
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-5023
Country	:	US
Telephone Number	:	205-261-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 57TH ST N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3328
Country	:	US
Telephone Number	:	205-261-1125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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Directions to “ KIMITRIA SMITH LICSW” Practice Location

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