Provider Demographics
NPI:1396971180
Name:SMITH, STANLEY GEORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:GEORGE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 TERMINAL DR
Mailing Address - Street 2:N/A
Mailing Address - City:MOSELLE
Mailing Address - State:MS
Mailing Address - Zip Code:39459-9546
Mailing Address - Country:US
Mailing Address - Phone:601-545-8006
Mailing Address - Fax:601-545-1867
Practice Address - Street 1:1015 TERMINAL DR
Practice Address - Street 2:N/A
Practice Address - City:MOSELLE
Practice Address - State:MS
Practice Address - Zip Code:39459-9546
Practice Address - Country:US
Practice Address - Phone:601-545-8006
Practice Address - Fax:601-545-1867
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health