Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1389 | KY |
N | 103TC0700X | Clinical Psychologist | 1389 | KY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1389 | KY |
NPI | 1083703441 |
---|---|
Provider Name | Dr. Felicia D Smith |
First Address | Charlotte, NC 28289-0527 |
Second Address | Louisville, KY 40202-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1389 | PSYCHOLOGY LICENSE (01) | KY |