Provider Demographics
NPI:1093215261
Name:SMITH, ERCELIA ESTELA (LPS, LCDC)
Entity Type:Individual
Prefix:
First Name:ERCELIA
Middle Name:ESTELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STADIUM DR APT 1003
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-2548
Mailing Address - Country:US
Mailing Address - Phone:979-319-0713
Mailing Address - Fax:
Practice Address - Street 1:4 STADIUM DR
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-2543
Practice Address - Country:US
Practice Address - Phone:979-319-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14114101YA0400X
TX79111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)