Provider Demographics
NPI:1306380506
Name:SMITH, ELIZABETH L (RBT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3760 LAVISTA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5622
Mailing Address - Country:US
Mailing Address - Phone:843-615-5545
Mailing Address - Fax:678-288-7932
Practice Address - Street 1:3760 LAVISTA RD STE 102
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5622
Practice Address - Country:US
Practice Address - Phone:843-615-5545
Practice Address - Fax:678-288-7932
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician