Provider Demographics
NPI:1043536709
Name:EUBANKS SMITH, KIU AMANI (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIU
Middle Name:AMANI
Last Name:EUBANKS SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 YORK RD
Mailing Address - Street 2:2ND FLOOR #12
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:443-453-5045
Mailing Address - Fax:443-863-6262
Practice Address - Street 1:9616 REISTERSTOWN RD
Practice Address - Street 2:PHENIX SALON - SUITE 109
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:443-453-5045
Practice Address - Fax:443-863-6262
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4323103T00000X
MD05244103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058535100Medicaid