Healthcare Provider Details

I. General information

NPI: 1689046716
Provider Name (Legal Business Name): DEIDRA SMITH DISABILITY COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 KINGS HWY SUITE 302
DOVER DE
19901-7308
US

IV. Provider business mailing address

144 KINGS HWY SUITE 302
DOVER DE
19901-7308
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-1555
  • Fax: 206-888-4342
Mailing address:
  • Phone: 302-677-1555
  • Fax: 206-888-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: