Provider Demographics
NPI:1033577911
Name:SMITH, EMMA JACKSON (NCC, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JACKSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:NCC, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 CREEKLAND VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-3093
Mailing Address - Country:US
Mailing Address - Phone:973-903-6863
Mailing Address - Fax:
Practice Address - Street 1:2017 CREEKLAND VIEW BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-3093
Practice Address - Country:US
Practice Address - Phone:973-903-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008031101YP2500X
MDLC10930101YP2500X
DCPRC15436101YP2500X
TX72052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional