Provider Demographics
NPI:1093050338
Name:SMITH, LASHONDA YVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LASHONDA
Middle Name:YVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 CAMPBELL THICKETT RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29472-6339
Mailing Address - Country:US
Mailing Address - Phone:843-821-3073
Mailing Address - Fax:
Practice Address - Street 1:331 CAMPBELL THICKETT RD
Practice Address - Street 2:
Practice Address - City:RIDGEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29472-6339
Practice Address - Country:US
Practice Address - Phone:843-821-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical