Healthcare Provider Details

I. General information

NPI: 1912934662
Provider Name (Legal Business Name): BRENDA L SMITH ED.D. LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

IV. Provider business mailing address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-6008
  • Fax: 870-541-6034
Mailing address:
  • Phone: 870-541-6008
  • Fax: 870-541-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number910C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: