Provider Demographics
NPI:1972055705
Name:SMITH, ADONIS DORREL
Entity Type:Individual
Prefix:
First Name:ADONIS
Middle Name:DORREL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:PORT SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70083-0689
Mailing Address - Country:US
Mailing Address - Phone:504-638-2856
Mailing Address - Fax:
Practice Address - Street 1:5000 WOODLAND DR
Practice Address - Street 2:APT 445
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131
Practice Address - Country:US
Practice Address - Phone:504-638-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician