Provider Demographics
NPI:1851662050
Name:ROBERTSON-SMITH, MISTY D (PHD, LPC, CEAP, NCC)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:D
Last Name:ROBERTSON-SMITH
Suffix:
Gender:F
Credentials:PHD, LPC, CEAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 VALLEYDALE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1703
Mailing Address - Country:US
Mailing Address - Phone:205-522-6113
Mailing Address - Fax:205-383-3253
Practice Address - Street 1:1920 VALLEYDALE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1703
Practice Address - Country:US
Practice Address - Phone:205-522-6113
Practice Address - Fax:205-383-3253
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2082101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor