Provider Demographics
NPI:1770297152
Name:SMITH, JAMIE G (RMHCI)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MORNINGSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2600
Mailing Address - Country:US
Mailing Address - Phone:863-606-6001
Mailing Address - Fax:863-606-6003
Practice Address - Street 1:107 MORNINGSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2600
Practice Address - Country:US
Practice Address - Phone:863-606-6001
Practice Address - Fax:863-606-6003
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health