Provider Demographics
NPI:1881761096
Name:SMITH, ALFRED T (MSW, CSAC-II)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, CSAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-2415
Mailing Address - Country:US
Mailing Address - Phone:605-845-7181
Mailing Address - Fax:605-845-5072
Practice Address - Street 1:1245 HWY 1806TH
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601
Practice Address - Country:US
Practice Address - Phone:605-845-7181
Practice Address - Fax:605-845-5072
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)