Provider Demographics
NPI:1508548447
Name:SMITH, JENNIFER GRACE (P-LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GRACE
Last Name:SMITH
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GRACE
Other - Last Name:CARNAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1064 MCCULLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-3519
Mailing Address - Country:US
Mailing Address - Phone:662-546-0680
Mailing Address - Fax:
Practice Address - Street 1:1014 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2211
Practice Address - Country:US
Practice Address - Phone:662-546-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health