Provider Demographics
NPI:1972252831
Name:SMITH, NICHOLE RENE' (MSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RENE'
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N FRUITLAND ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3814
Mailing Address - Country:US
Mailing Address - Phone:509-581-0303
Mailing Address - Fax:
Practice Address - Street 1:100 N FRUITLAND ST STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3814
Practice Address - Country:US
Practice Address - Phone:509-581-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health