Provider Demographics
NPI:1013106749
Name:SMITH, AMBER DAVELINE (LMHC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAVELINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 INNOVATION DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6501
Mailing Address - Country:US
Mailing Address - Phone:407-922-4390
Mailing Address - Fax:407-429-3977
Practice Address - Street 1:3121 INNOVATION DR STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6501
Practice Address - Country:US
Practice Address - Phone:407-922-4390
Practice Address - Fax:407-429-3977
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional