Provider Demographics
NPI:1467198499
Name:SMITH, EBONE TENISHA
Entity Type:Individual
Prefix:MS
First Name:EBONE
Middle Name:TENISHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 TOWN CENTER DR. SUITE 130 UNIT #142
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-694-8987
Mailing Address - Fax:
Practice Address - Street 1:9451 COATS RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NC
Practice Address - Zip Code:28356-9563
Practice Address - Country:US
Practice Address - Phone:910-694-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency