Provider Demographics
NPI:1114374733
Name:SMALL, BELLA (MS, CAC)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:MS, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 NW 33RD ST APT 1902
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6480
Mailing Address - Country:US
Mailing Address - Phone:954-294-4040
Mailing Address - Fax:
Practice Address - Street 1:2642 NW 33RD ST APT 1902
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-6480
Practice Address - Country:US
Practice Address - Phone:954-294-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)