Provider Demographics
NPI:1083002703
Name:S.M.I.L.E. PSYCHOLOGY AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:S.M.I.L.E. PSYCHOLOGY AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLEAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-569-6305
Mailing Address - Street 1:3831 TYRONE BLVD N STE 201E
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4114
Mailing Address - Country:US
Mailing Address - Phone:727-569-6305
Mailing Address - Fax:
Practice Address - Street 1:3831 TYRONE BLVD N STE 201E
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4114
Practice Address - Country:US
Practice Address - Phone:727-569-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10595251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health