Provider Demographics
NPI:1083335541
Name:SMAJLAGIC, TINA (CSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SMAJLAGIC
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FOX FIRE CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1220
Mailing Address - Country:US
Mailing Address - Phone:270-300-4148
Mailing Address - Fax:
Practice Address - Street 1:3300 FOX FIRE CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1220
Practice Address - Country:US
Practice Address - Phone:270-300-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253114104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty