Provider Demographics
NPI:1154680270
Name:SMITH, CHARMAINE MARIA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6697
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0697
Mailing Address - Country:US
Mailing Address - Phone:502-804-5410
Mailing Address - Fax:
Practice Address - Street 1:2210 GOLDSMITH LN STE 208C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1038
Practice Address - Country:US
Practice Address - Phone:502-804-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist