Provider Demographics
NPI:1811423999
Name:JILL SMITH THERAPY
Entity Type:Organization
Organization Name:JILL SMITH THERAPY
Other - Org Name:JILL SMITH AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-530-9994
Mailing Address - Street 1:130 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3429
Mailing Address - Country:US
Mailing Address - Phone:803-530-9994
Mailing Address - Fax:
Practice Address - Street 1:570 HARBOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9369
Practice Address - Country:US
Practice Address - Phone:803-530-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006653251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health