Provider Demographics
NPI:1306676499
Name:SMITH, ASHTON BRIANA
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:BRIANA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BERNARD CIR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7641
Mailing Address - Country:US
Mailing Address - Phone:251-447-3501
Mailing Address - Fax:
Practice Address - Street 1:28119 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7090
Practice Address - Country:US
Practice Address - Phone:251-447-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26251101YM0800X
ALALC04967101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health