Provider Demographics
NPI:1013033406
Name:SMITH, AMBER MICHELLE (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E 1000TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:IL
Mailing Address - Zip Code:62411-3414
Mailing Address - Country:US
Mailing Address - Phone:618-483-5749
Mailing Address - Fax:
Practice Address - Street 1:802 N 8TH ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1756
Practice Address - Country:US
Practice Address - Phone:618-293-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional