Provider Demographics
NPI:1770365231
Name:SMITH, TIARA SIMONE (MA, RMHCI)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:SIMONE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 S INTERNATIONAL PKWY STE 2051
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1414
Mailing Address - Country:US
Mailing Address - Phone:407-284-1191
Mailing Address - Fax:
Practice Address - Street 1:1307 S INTERNATIONAL PKWY STE 2051
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1414
Practice Address - Country:US
Practice Address - Phone:407-284-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health