Provider Demographics
NPI:1396220547
Name:SMITH, SHARLEA SMOOT (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARLEA
Middle Name:SMOOT
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3734
Mailing Address - Country:US
Mailing Address - Phone:318-245-7154
Mailing Address - Fax:
Practice Address - Street 1:302 PARADISE RD
Practice Address - Street 2:
Practice Address - City:BALL
Practice Address - State:LA
Practice Address - Zip Code:71405-3734
Practice Address - Country:US
Practice Address - Phone:318-245-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty