Provider Demographics
NPI:1821533456
Name:SMALLS, SHARICA
Entity Type:Individual
Prefix:MS
First Name:SHARICA
Middle Name:
Last Name:SMALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 VINERIDGE RUN
Mailing Address - Street 2:APT 305
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1761
Mailing Address - Country:US
Mailing Address - Phone:407-579-1773
Mailing Address - Fax:
Practice Address - Street 1:1601 PARK CENTER DR
Practice Address - Street 2:STE. 7
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:407-730-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health