Healthcare Provider Details

I. General information

NPI: 1316580095
Provider Name (Legal Business Name): LAUREL SMITH MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E GENERAL STEWART WAY STE 103
HINESVILLE GA
31313-2636
US

IV. Provider business mailing address

611 MERCER ST
SAVANNAH GA
31401-5822
US

V. Phone/Fax

Practice location:
  • Phone: 877-321-2899
  • Fax:
Mailing address:
  • Phone: 910-691-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: