Provider Demographics
NPI:1255611927
Name:SMITH-BADSON, TAMIKA MARKITA
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:MARKITA
Last Name:SMITH-BADSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2292
Mailing Address - Country:US
Mailing Address - Phone:302-832-8848
Mailing Address - Fax:
Practice Address - Street 1:109 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2236
Practice Address - Country:US
Practice Address - Phone:302-652-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)