Provider Demographics
NPI:1497393581
Name:SMITH, TANEKIA DANIELLE (LPC)
Entity Type:Individual
Prefix:
First Name:TANEKIA
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3000
Mailing Address - Country:US
Mailing Address - Phone:205-836-7283
Mailing Address - Fax:205-836-7824
Practice Address - Street 1:129 E PARK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3000
Practice Address - Country:US
Practice Address - Phone:205-836-7283
Practice Address - Fax:205-836-7824
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00000000Medicaid
AL00000000OtherBLUE CROSS BLUE SHIELD ALABAMA