Provider Demographics
NPI:1245558444
Name:SMITH, NICOLE CRAFT (MS THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CRAFT
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 TABERNACLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-8954
Mailing Address - Country:US
Mailing Address - Phone:251-765-3276
Mailing Address - Fax:
Practice Address - Street 1:530 HORNADY DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-8658
Practice Address - Country:US
Practice Address - Phone:251-575-4837
Practice Address - Fax:251-575-5266
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health