Provider Demographics
NPI:1568516508
Name:SMALLS, VEEDA JENE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:VEEDA
Middle Name:JENE
Last Name:SMALLS
Suffix:
Gender:F
Credentials:MA, LPC
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 1627
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1627
Mailing Address - Country:US
Mailing Address - Phone:803-775-5261
Mailing Address - Fax:803-773-8111
Practice Address - Street 1:533 OXFORD ST
Practice Address - Street 2:SUITE D
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3353
Practice Address - Country:US
Practice Address - Phone:803-775-5261
Practice Address - Fax:803-773-8111
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
228841OtherCOMPSYCH
717761000OtherMAGELLAN
SCGP3846Medicaid
11618685OtherCAQH
499995OtherVALUE OPTION