Provider Demographics
NPI:1821215138
Name:SMITH, MICHAEL CRAIG (MED, LPC, CDCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CRAIG
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED, LPC, CDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 HOSPITAL DRIVE
Mailing Address - Street 2:RAINFOREST RECOVERY CENTER
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-796-8690
Mailing Address - Fax:
Practice Address - Street 1:3250 HOSPITAL DRIVE
Practice Address - Street 2:RAINFOREST RECOVERY CENTER
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-796-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2726101YP2500X
AKPCOP739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional