Provider Demographics
NPI:1225265218
Name:SMITH, RONICA C (MS)
Entity Type:Individual
Prefix:MRS
First Name:RONICA
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
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Mailing Address - Street 1:1804 HIGHWAY 45 BYP
Mailing Address - Street 2:604
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4436
Mailing Address - Country:US
Mailing Address - Phone:731-660-8781
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:4039 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3483
Practice Address - Country:US
Practice Address - Phone:731-723-1327
Practice Address - Fax:731-723-1339
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN60261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health