Provider Demographics
NPI:1851965065
Name:SMITH, BEN (ALCHOHOL AND DRUG CO)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:ALCHOHOL AND DRUG CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 BLUE LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2372
Mailing Address - Country:US
Mailing Address - Phone:205-977-3003
Mailing Address - Fax:205-977-3939
Practice Address - Street 1:3104 BLUE LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2372
Practice Address - Country:US
Practice Address - Phone:205-977-3003
Practice Address - Fax:205-977-3939
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALADC648101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALADC-648OtherALABAMA ALCOHOL AND DRUG ABUSE ASSOCIATION