Healthcare Provider Details

I. General information

NPI: 1902043797
Provider Name (Legal Business Name): EKIBA SMITH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 HAMLIN AVE UNIT G
SAINT CLOUD FL
34771-8590
US

IV. Provider business mailing address

1427 BELLADONNA PL # 1018
SAINT CLOUD FL
34771-5813
US

V. Phone/Fax

Practice location:
  • Phone: 407-676-4276
  • Fax: 407-794-9175
Mailing address:
  • Phone: 407-676-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: