Provider Demographics
NPI:1770341059
Name:SMEDLEY, GENEVA L (CAP)
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:L
Last Name:SMEDLEY
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:GENEVA
Other - Middle Name:LOUISE
Other - Last Name:SMEDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 NW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1193
Mailing Address - Country:US
Mailing Address - Phone:561-613-3598
Mailing Address - Fax:
Practice Address - Street 1:100 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1193
Practice Address - Country:US
Practice Address - Phone:561-613-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLICADC.0000139101YA0400X
FLCBHCM.0103735171M00000X
FLCAP.0100494101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator