Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003584384 |
---|---|
Provider Name | Cherisa Gail Smith |
First Address | Lexington, KY 40505-9009 |
Second Address | Hazard, KY 41701-6081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 01/09/2021 |