Provider Demographics
NPI:1801470521
Name:SMITH, ADRIANNE RALPH (LMHC MH 15560)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:RALPH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC MH 15560
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 BAMBI DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1833
Mailing Address - Country:US
Mailing Address - Phone:850-685-0668
Mailing Address - Fax:
Practice Address - Street 1:916 BAMBI DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-1833
Practice Address - Country:US
Practice Address - Phone:850-685-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty