Provider Demographics
NPI:1235827965
Name:SMITH, DARIONNE AMBER (LCPC)
Entity Type:Individual
Prefix:
First Name:DARIONNE
Middle Name:AMBER
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 TREYBROOKE PL
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4132
Mailing Address - Country:US
Mailing Address - Phone:618-972-1568
Mailing Address - Fax:
Practice Address - Street 1:1941 FRANK SCOTT PKWY E STE C
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-7387
Practice Address - Country:US
Practice Address - Phone:618-972-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017889101YM0800X
IL180.015825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health