Provider Demographics
NPI:1366930596
Name:SMITH, ALTRAVEISE MELVINA (MS)
Entity type:Individual
Prefix:MISS
First Name:ALTRAVEISE
Middle Name:MELVINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:380 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3502
Mailing Address - Country:US
Mailing Address - Phone:954-782-9774
Mailing Address - Fax:954-782-3843
Practice Address - Street 1:380 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3502
Practice Address - Country:US
Practice Address - Phone:954-782-9774
Practice Address - Fax:954-782-3843
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)