MEDICARE: KENOYA SMITH LCSW

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
1	1041C0700X	Clinical Social Worker	P010794	NC
2	1041C0700X	Clinical Social Worker	SW26381	FL
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	130972	OH

General Provider Information

NPI Number	:	1942756739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENOYA SMITH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 748519
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8519
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 PRUDENTIAL DR STE 512
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8207
Country	:	US
Telephone Number	:	904-202-7900
Fax Number	:	904-390-7398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	06/02/2026

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Directions to “ KENOYA SMITH LCSW” Practice Location

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