Provider Demographics
NPI:1407479652
Name:SMITH, SIDNEY H III (LMSW, PCMHT, CPSS)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:H
Last Name:SMITH
Suffix:III
Gender:M
Credentials:LMSW, PCMHT, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 PASS RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4103
Mailing Address - Country:US
Mailing Address - Phone:228-207-1248
Mailing Address - Fax:228-388-6182
Practice Address - Street 1:1989 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4103
Practice Address - Country:US
Practice Address - Phone:228-207-1248
Practice Address - Fax:228-388-6182
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9328101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)