Provider Demographics
NPI:1689046716
Name:SMITH, DEIDRA (DISABILITY COACH)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DISABILITY COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 KINGS HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7308
Mailing Address - Country:US
Mailing Address - Phone:302-677-1555
Mailing Address - Fax:206-888-4342
Practice Address - Street 1:144 KINGS HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7308
Practice Address - Country:US
Practice Address - Phone:302-677-1555
Practice Address - Fax:206-888-4342
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities