Provider Demographics
NPI:1750327458
Name:SMITH, NANCY JOY (LPC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JOY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:JOY
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:235 HUGHES RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1142
Mailing Address - Country:US
Mailing Address - Phone:256-924-2101
Mailing Address - Fax:
Practice Address - Street 1:235 HUGHES RD
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1142
Practice Address - Country:US
Practice Address - Phone:256-924-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1002103TH0100X
AL3224101YP2500X
TNLPC43101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I689196Medicare PIN
TN4282035OtherBLUE CROSS/BLUE SHIELD