Provider Demographics
NPI:1184334054
Name:SMALLWOOD, AUDRA (MS, LBS)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LBS
Mailing Address - Street 1:200 SPRING RIDGE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3334
Mailing Address - Country:US
Mailing Address - Phone:610-927-6593
Mailing Address - Fax:
Practice Address - Street 1:200 SPRING RIDGE DR STE 103
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3334
Practice Address - Country:US
Practice Address - Phone:610-927-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health