Provider Demographics
NPI:1417587023
Name:SMITH, KESIAH STASHA (LBS)
Entity Type:Individual
Prefix:MS
First Name:KESIAH
Middle Name:STASHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:KESIAH
Other - Middle Name:STASHA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBS
Mailing Address - Street 1:224 NAZARETH PIKE UNIT 22A
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9084
Mailing Address - Country:US
Mailing Address - Phone:858-229-1024
Mailing Address - Fax:610-365-2522
Practice Address - Street 1:224 NAZARETH PIKE UNIT 22A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9084
Practice Address - Country:US
Practice Address - Phone:858-229-1024
Practice Address - Fax:610-365-2522
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health