Provider Demographics
NPI:1518453901
Name:SMITH, SHELINA FAITH (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHELINA
Middle Name:FAITH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 88TH AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3756
Mailing Address - Country:US
Mailing Address - Phone:678-230-6962
Mailing Address - Fax:
Practice Address - Street 1:15209 88TH AVE APT 403
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3756
Practice Address - Country:US
Practice Address - Phone:678-230-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006850101YP2500X
101YS0200X
GALPC013274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty