Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003248337 |
---|---|
Provider Name | Suntia Smith |
First Address | Greenville, SC 29607-5768 |
Second Address | Greenville, SC 29607-5768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2013 |
Last Update Date | 16/11/2014 |