Provider Demographics
NPI:1326668377
Name:SMITH, FELICIA RAE
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 CAMINO DE SUENOS
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7813
Mailing Address - Country:US
Mailing Address - Phone:915-253-9810
Mailing Address - Fax:
Practice Address - Street 1:2215 CAMINO DE SUENOS
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7813
Practice Address - Country:US
Practice Address - Phone:915-253-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician