Provider Demographics
NPI:1285040279
Name:SMART, DEBRA R
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:SMART
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:R
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP (TEMP)
Mailing Address - Street 1:652 BUSH RIVER RD STE 216
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7537
Mailing Address - Country:US
Mailing Address - Phone:615-243-7468
Mailing Address - Fax:
Practice Address - Street 1:652 BUSH ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:615-243-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional