Provider Demographics
NPI:1558068767
Name:SMITH, RHONDA STEPHANIE (ALC, MA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:STEPHANIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ALC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 BROOKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1536
Mailing Address - Country:US
Mailing Address - Phone:205-202-0380
Mailing Address - Fax:
Practice Address - Street 1:300 VESTAVIA PKWY STE 2600
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-7704
Practice Address - Country:US
Practice Address - Phone:205-202-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04378101Y00000X
ALC04378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor