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NPI Code Detail

MEDICARE: DAMITRA SMITH LPC, LCDC

MEDICARE:   DAMITRA  SMITH  LPC, LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor13292TX
2101YP2500XProfessional Counselor80480TX

General Provider Information

NPI Number : 1295198109
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMITRA SMITH LPC, LCDC
Provider Business Mailing Address
First Line : 2717 COMMERCIAL CENTER BLVD STE E200
Second Line :
City : KATY
State : TX
Zip : 77494-7823
Country : US
Telephone Number : 832-449-6823
Fax Number :
Provider Business Practice Location Address
First Line : 2717 COMMERCIAL CENTER BLVD STE E200
Second Line :
City : KATY
State : TX
Zip : 77494-7823
Country : US
Telephone Number : 832-449-6823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2016
Last Update Date : 09/25/2023

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Directions to “ DAMITRA SMITH LPC, LCDC” Practice Location

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