Provider Demographics
NPI:1790799138
Name:SMOTHERS, CHRISTINE ANNETTE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNETTE
Last Name:SMOTHERS
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 1:10723 LILINOE WAY
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-4336
Mailing Address - Country:US
Mailing Address - Phone:228-255-3719
Mailing Address - Fax:
Practice Address - Street 1:127 GARY ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3503
Practice Address - Country:US
Practice Address - Phone:228-328-1202
Practice Address - Fax:228-328-2522
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional