Provider Demographics
NPI:1184310542
Name:SMART, NICOLE LEANNE (CIT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEANNE
Last Name:SMART
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-6102
Mailing Address - Country:US
Mailing Address - Phone:870-353-8367
Mailing Address - Fax:
Practice Address - Street 1:4956 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929-6102
Practice Address - Country:US
Practice Address - Phone:870-353-8367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)