Provider Demographics
NPI:1679903041
Name:SMITH, JOANNA (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 1ST CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3802
Mailing Address - Country:US
Mailing Address - Phone:727-409-6239
Mailing Address - Fax:
Practice Address - Street 1:702 1ST COURT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3729
Practice Address - Country:US
Practice Address - Phone:727-409-6239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health