Provider Demographics
NPI:1881932085
Name:SMITH, JEREMY MICHAEL (NCC, LPC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 DEBRA AVE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2008
Mailing Address - Country:US
Mailing Address - Phone:205-280-7733
Mailing Address - Fax:
Practice Address - Street 1:232 TOWN MART
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3784
Practice Address - Country:US
Practice Address - Phone:205-280-7733
Practice Address - Fax:205-280-7737
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2723101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health