Provider Demographics
NPI:1679797062
Name:SMITH, JANICE RENE (MS)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:RENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 MEADOWBANK ROAD
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:901-757-8825
Mailing Address - Fax:
Practice Address - Street 1:427 LINDEN AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126
Practice Address - Country:US
Practice Address - Phone:901-577-0221
Practice Address - Fax:901-577-0229
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health