Provider Demographics
NPI:1164206405
Name:SMITH, TONITA BELL (LCMHCA)
Entity Type:Individual
Prefix:
First Name:TONITA
Middle Name:BELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FORK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-0693
Mailing Address - Country:US
Mailing Address - Phone:910-305-6597
Mailing Address - Fax:
Practice Address - Street 1:175 FORK LAKE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-0693
Practice Address - Country:US
Practice Address - Phone:910-305-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health