Provider Demographics
NPI:1225187396
Name:SMITH, LONNA DIONE (MAMFT)
Entity Type:Individual
Prefix:MS
First Name:LONNA
Middle Name:DIONE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MAMFT
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 7864
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0864
Mailing Address - Country:US
Mailing Address - Phone:502-649-4143
Mailing Address - Fax:502-327-8994
Practice Address - Street 1:4012 DUPONT CIR
Practice Address - Street 2:SUITE 213
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4813
Practice Address - Country:US
Practice Address - Phone:502-649-4143
Practice Address - Fax:502-327-8994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0625OtherMARRIAGE &FAMILY THERAPY