Provider Demographics
NPI:1750409165
Name:SMITH, GEORGE ALVIN (MA, LCPC, CSADC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALVIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, LCPC, CSADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 FEHLING RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3633
Mailing Address - Country:US
Mailing Address - Phone:618-452-3032
Mailing Address - Fax:
Practice Address - Street 1:50 NORTHGATE IND. DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-877-4420
Practice Address - Fax:618-877-0904
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003531101YA0400X, 101YM0800X
IL180.003531101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health