Provider Demographics
NPI:1255463824
Name:SMITH, ARDRENIA COLLINS
Entity type:Individual
Prefix:
First Name:ARDRENIA
Middle Name:COLLINS
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARDRENIA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 N.E. 209 STREET
Mailing Address - Street 2:#209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179
Mailing Address - Country:US
Mailing Address - Phone:305-653-4835
Mailing Address - Fax:954-497-3857
Practice Address - Street 1:4720 N STATE ROAD 7
Practice Address - Street 2:BLDG B
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5860
Practice Address - Country:US
Practice Address - Phone:954-497-3856
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator