Provider Demographics
NPI:1548392970
Name:SMITH, ALEXINE C (LMHC, LCAC, NCC,CSMS)
Entity Type:Individual
Prefix:MS
First Name:ALEXINE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC, LCAC, NCC,CSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 PRISCILLA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-3338
Mailing Address - Country:US
Mailing Address - Phone:317-579-1030
Mailing Address - Fax:317-547-5212
Practice Address - Street 1:4464 PRISCILLA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-3338
Practice Address - Country:US
Practice Address - Phone:317-579-1030
Practice Address - Fax:317-547-5212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001278A101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health