Provider Demographics
NPI:1689384828
Name:SMART, SAMANTHA CODI (LPC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:CODI
Last Name:SMART
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 1:4646 CORONA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4320
Mailing Address - Country:US
Mailing Address - Phone:361-302-1600
Mailing Address - Fax:
Practice Address - Street 1:7601 PIRATES DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3304
Practice Address - Country:US
Practice Address - Phone:337-552-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional