Provider Demographics
NPI:1013412592
Name:SMITH, ADAM GABRIEL
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GABRIEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12423 MOUNTAIN DOVE RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-2704
Mailing Address - Country:US
Mailing Address - Phone:352-942-0925
Mailing Address - Fax:
Practice Address - Street 1:12423 MOUNTAIN DOVE RD
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-2704
Practice Address - Country:US
Practice Address - Phone:352-942-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician