Provider Demographics
NPI:1134410467
Name:SMITH, DALISHA LAREECE (MHPP)
Entity type:Individual
Prefix:MRS
First Name:DALISHA
Middle Name:LAREECE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11064
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1001
Mailing Address - Country:US
Mailing Address - Phone:870-520-5014
Mailing Address - Fax:479-323-3912
Practice Address - Street 1:1792 FALLS BLVD N STE 5
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4093
Practice Address - Country:US
Practice Address - Phone:870-208-9333
Practice Address - Fax:479-323-3912
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174V00000X, 171M00000X
ARP2306029101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174V00000XOther Service ProvidersClinical Ethicist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator