Provider Demographics
NPI:1447928106
Name:SMITH, ARIELLE ELYCE (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:ARIELLE
Middle Name:ELYCE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 GOVERNORS HWY STE 30
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1145
Mailing Address - Country:US
Mailing Address - Phone:618-319-5669
Mailing Address - Fax:
Practice Address - Street 1:17901 GOVERNORS HWY STE 30
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1145
Practice Address - Country:US
Practice Address - Phone:618-319-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490236971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty