Provider Demographics
NPI:1487225512
Name:SMITH, NATASHA MONIQUE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MONIQUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 CARILLION PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8813
Mailing Address - Country:US
Mailing Address - Phone:334-201-2539
Mailing Address - Fax:
Practice Address - Street 1:8518 CARILLION PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8813
Practice Address - Country:US
Practice Address - Phone:334-201-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3012101YM0800X, 101YP2500X
AL4453101YP2500X
NH111360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health