Doctor Name: | SONJA TULLOS SMITH |
NPI Number: | 1568848067 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LAC 978 |
License Number: | 978 |
Business Practice Address: | 804 N 2nd St Amite, LA - 704222117 |
Business Phone Number: | 9855171711 |
Business Fax Number: | 9857478836 |
Mailing Address: | 804 N 2nd St, AMITE |
State: | LA |
Postal Code: | 704222117 |
Phone Number: | 9855171711 |
Fax Number: | 9857478836 |
NPI Enumeration Date: | 08/06/2015 |
NPI Last Update Date: | 08/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 978 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |