Provider Demographics
NPI:1790011708
Name:ZENOBIA A SMITH
Entity Type:Organization
Organization Name:ZENOBIA A SMITH
Other - Org Name:AGAPE PHASE2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DICETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENOBIA
Authorized Official - Middle Name:ARETTA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-638-9322
Mailing Address - Street 1:14222 KIMBERLEY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4803
Mailing Address - Country:US
Mailing Address - Phone:832-638-9322
Mailing Address - Fax:
Practice Address - Street 1:14222 KIMBERLEY LN APT 470
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4811
Practice Address - Country:US
Practice Address - Phone:832-638-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty