Provider Demographics
NPI:1033348503
Name:SMITH, PAMELA D (EDD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4719
Mailing Address - Country:US
Mailing Address - Phone:205-221-9232
Mailing Address - Fax:205-221-5512
Practice Address - Street 1:1611 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4719
Practice Address - Country:US
Practice Address - Phone:205-221-9232
Practice Address - Fax:205-221-5512
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1298A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional