Provider Demographics
NPI:1518216449
Name:SMILIE, MELISSA AGERTON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:AGERTON
Last Name:SMILIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:BROOKE
Other - Last Name:AGERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 C DAPHNE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-227-4472
Mailing Address - Fax:
Practice Address - Street 1:809 C DAPHNE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-227-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3041101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional