Provider Demographics
NPI:1851681761
Name:SMITH, LAURIE LOU (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LOU
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD AVE S
Mailing Address - Street 2:CH19-307
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2041
Mailing Address - Country:US
Mailing Address - Phone:205-934-5471
Mailing Address - Fax:205-975-2380
Practice Address - Street 1:930 20TH ST S
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2610
Practice Address - Country:US
Practice Address - Phone:205-934-5471
Practice Address - Fax:205-975-2380
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
34777103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool