Provider Demographics
NPI:1720443534
Name:SMITH, WILLIAM JR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11307 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-7513
Mailing Address - Country:US
Mailing Address - Phone:504-265-0996
Mailing Address - Fax:504-265-8340
Practice Address - Street 1:6305 ELYSIAN FIELDS AVE STE 404
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4293
Practice Address - Country:US
Practice Address - Phone:504-281-7735
Practice Address - Fax:504-265-8340
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health