Provider Demographics
NPI:1306904701
Name:SMITH, MICHELLE WOODS (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:WOODS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:STE. 44B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-471-1234
Mailing Address - Fax:850-478-1234
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:STE. 44B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-471-1234
Practice Address - Fax:850-478-1234
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92481041C0700X
AL1363C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical