Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 104100000X | Social Worker |
NPI | 1003243833 |
---|---|
Provider Name | Ayana Smith |
First Address | Memphis, TN 38125-8900 |
Second Address | Memphis, TN 38125-8900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2013 |
Last Update Date | 11/10/2013 |