Provider Demographics
NPI:1811985690
Name:SMITH, VONCEIL CORNELIUS (PHD)
Entity type:Individual
Prefix:
First Name:VONCEIL
Middle Name:CORNELIUS
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SOUTH TWINING STREET
Mailing Address - Street 2:BUILDING 760
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6219
Mailing Address - Country:US
Mailing Address - Phone:334-953-4943
Mailing Address - Fax:
Practice Address - Street 1:6707 TAYLOR CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7706
Practice Address - Country:US
Practice Address - Phone:334-272-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890009810Medicaid
AL051514378OtherBLUE CROSS
AL890009810Medicaid
AL051553240Medicare ID - Type Unspecified