Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IMH19446 | FL |
N | 101YP2500X | Professional Counselor | LPCC.0016821 | CO |
NPI | 1003459660 |
---|---|
Provider Name | Ms. Ashley Brook Smith |
First Address | Mount Dora, FL 32757-3312 |
Second Address | Mount Dora, FL 32757-3312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 11/05/2021 |