Provider Demographics
NPI:1104683952
Name:SMOOT, KAYDIAN LEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAYDIAN
Middle Name:LEE
Last Name:SMOOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KAYDIAN
Other - Middle Name:LEE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 LONGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7231
Mailing Address - Country:US
Mailing Address - Phone:205-512-1069
Mailing Address - Fax:205-512-1069
Practice Address - Street 1:15 LONGWOOD PL
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7231
Practice Address - Country:US
Practice Address - Phone:205-512-1069
Practice Address - Fax:205-512-1069
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5861G104100000X
AL5978C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker