Provider Demographics
NPI:1376836007
Name:SMITHAM, DELORES A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DELORES
Middle Name:A
Last Name:SMITHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LORA
Other - Middle Name:
Other - Last Name:SMITHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9825 N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4590
Mailing Address - Country:US
Mailing Address - Phone:480-941-4247
Mailing Address - Fax:480-941-4010
Practice Address - Street 1:9825 N 95TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4590
Practice Address - Country:US
Practice Address - Phone:480-941-4247
Practice Address - Fax:480-941-4010
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4181103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling