Provider Demographics
NPI:1023285558
Name:SMITH, LEAH ELDER (MSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ELDER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ST CLAIR AVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5707
Mailing Address - Country:US
Mailing Address - Phone:256-536-4700
Mailing Address - Fax:256-536-4117
Practice Address - Street 1:600 ST CLAIR AVE
Practice Address - Street 2:BLDG 3
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5707
Practice Address - Country:US
Practice Address - Phone:256-536-4700
Practice Address - Fax:256-536-4117
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2311C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-92614OtherBLUE CROSS BLUE SHIELD
AL330000025Medicaid