Provider Demographics
NPI:1598120362
Name:SMITH, GREGORY (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2124 MOORES MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8468
Mailing Address - Country:US
Mailing Address - Phone:334-501-7829
Mailing Address - Fax:
Practice Address - Street 1:2124 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8468
Practice Address - Country:US
Practice Address - Phone:334-501-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1462101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral