Provider Demographics
NPI:1093494361
Name:SMITH, ALVIN RUSSELL JR (LGSW)
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:RUSSELL
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 Q ST NE APT 3511
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2291
Mailing Address - Country:US
Mailing Address - Phone:202-819-4127
Mailing Address - Fax:
Practice Address - Street 1:4808 43RD PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4502
Practice Address - Country:US
Practice Address - Phone:202-819-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200001832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health