Provider Demographics
NPI:1508251794
Name:HANCOCK-SMITH, ANYALIESE DOMINIQUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANYALIESE
Middle Name:DOMINIQUE
Last Name:HANCOCK-SMITH
Suffix:
Gender:F
Credentials:PHD
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 305
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32616-0305
Mailing Address - Country:US
Mailing Address - Phone:386-518-6006
Mailing Address - Fax:386-518-6024
Practice Address - Street 1:13900 TECH CITY CIR STE 408
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6090
Practice Address - Country:US
Practice Address - Phone:386-518-6006
Practice Address - Fax:386-518-6024
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9269103TC0700X
FLPY9269103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID725ZMedicare PIN