Provider Demographics
NPI:1700325040
Name:SMITH, LAWANDA DANIELLE (ALC)
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 6TH PL NW
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5348
Mailing Address - Country:US
Mailing Address - Phone:205-337-2428
Mailing Address - Fax:
Practice Address - Street 1:4268 CAHABA HEIGHTS CT
Practice Address - Street 2:SUITE 166
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5711
Practice Address - Country:US
Practice Address - Phone:205-259-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health