Provider Demographics
NPI:1699351247
Name:SMITH, RASHADA CAMILLE
Entity Type:Individual
Prefix:
First Name:RASHADA
Middle Name:CAMILLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-2930
Mailing Address - Country:US
Mailing Address - Phone:205-835-3029
Mailing Address - Fax:919-590-1895
Practice Address - Street 1:1400 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-9451
Practice Address - Country:US
Practice Address - Phone:256-365-8686
Practice Address - Fax:919-590-1895
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL261260Medicaid