Provider Demographics
NPI:1487477584
Name:SMOTHERS, RYAN W (LICSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:W
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MARTLING ROAD
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7208
Mailing Address - Country:US
Mailing Address - Phone:256-891-7724
Mailing Address - Fax:256-279-0534
Practice Address - Street 1:408 MARTLING ROAD
Practice Address - Street 2:SUITE 105A
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7208
Practice Address - Country:US
Practice Address - Phone:256-891-7724
Practice Address - Fax:256-279-0534
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5907C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical