Provider Demographics
NPI:1821728197
Name:SMITH, ANGELA KATRINA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KATRINA
Last Name:SMITH
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 1:55 SILVER PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-2323
Mailing Address - Country:US
Mailing Address - Phone:352-362-3795
Mailing Address - Fax:
Practice Address - Street 1:3230 NE 55TH AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-1721
Practice Address - Country:US
Practice Address - Phone:855-483-7800
Practice Address - Fax:352-509-5890
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health