Provider Demographics
NPI:1942765466
Name:ANNA FORD SMITH ART THERAPY, LLC
Entity type:Organization
Organization Name:ANNA FORD SMITH ART THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR-BC
Authorized Official - Phone:256-715-2356
Mailing Address - Street 1:303 WILLIAMS AVE SW STE 221
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6001
Mailing Address - Country:US
Mailing Address - Phone:256-715-2356
Mailing Address - Fax:
Practice Address - Street 1:303 WILLIAMS AVE SW STE 221
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6001
Practice Address - Country:US
Practice Address - Phone:256-715-2356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1073097911Medicaid
AL1356608350Medicaid