Provider Demographics
NPI:1194200204
Name:SMITH, SALLY (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CANAL ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6246
Mailing Address - Country:US
Mailing Address - Phone:504-913-5039
Mailing Address - Fax:504-324-2163
Practice Address - Street 1:3300 CANAL ST STE 120
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6246
Practice Address - Country:US
Practice Address - Phone:504-913-5039
Practice Address - Fax:504-324-2163
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional