Provider Demographics
NPI:1407434152
Name:SMITH, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
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 1:2751 LEGENDS PARKWAY
Mailing Address - Street 2:PMB 102
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066
Mailing Address - Country:US
Mailing Address - Phone:334-363-3359
Mailing Address - Fax:334-625-1853
Practice Address - Street 1:215 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3835
Practice Address - Country:US
Practice Address - Phone:334-363-3359
Practice Address - Fax:334-625-1853
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-21-162409106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician