Healthcare Provider Details

I. General information

NPI: 1366854101
Provider Name (Legal Business Name): DINA ELIZABETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINA ELIZABETH ORLANDO

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH11177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: