Provider Demographics
NPI:1407616170
Name:SMILEY, TISHA LYNN (LCASA)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:LYNN
Last Name:SMILEY
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0098
Mailing Address - Country:US
Mailing Address - Phone:252-477-0008
Mailing Address - Fax:252-303-0321
Practice Address - Street 1:109 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2528
Practice Address - Country:US
Practice Address - Phone:252-477-0008
Practice Address - Fax:252-303-0321
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)