Provider Demographics
NPI:1013363209
Name:SMITH, CHERYL ANN (MA,LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 MARGARET PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4521
Mailing Address - Country:US
Mailing Address - Phone:318-675-0406
Mailing Address - Fax:
Practice Address - Street 1:842 MARGARET PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4521
Practice Address - Country:US
Practice Address - Phone:318-675-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006418554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health