Provider Demographics
NPI:1962681148
Name:SMITH, DEBORAH A (CACII)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODS LAKE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6125
Mailing Address - Country:US
Mailing Address - Phone:864-293-0380
Mailing Address - Fax:
Practice Address - Street 1:4302 EDWARDS RD
Practice Address - Street 2:2 F
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-3330
Practice Address - Country:US
Practice Address - Phone:864-591-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09052614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2209837OtherCOMPSYCH