Provider Demographics
NPI:1205441060
Name:SMITH, CHASSITY ANNETTE (LICSW)
Entity type:Individual
Prefix:
First Name:CHASSITY
Middle Name:ANNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHASSITY
Other - Middle Name:ANNETTE
Other - Last Name:CHAMPION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5504 PARK SIDE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5123
Mailing Address - Country:US
Mailing Address - Phone:205-531-4932
Mailing Address - Fax:
Practice Address - Street 1:5401 E LAKE BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35217-3545
Practice Address - Country:US
Practice Address - Phone:205-531-4932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4482C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical