Healthcare Provider Details

I. General information

NPI: 1730092255
Provider Name (Legal Business Name): LATRIKA SHANEE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25566 PARDUE RD
SPRINGFIELD LA
70462-8516
US

IV. Provider business mailing address

25566 PARDUE RD
SPRINGFIELD LA
70462-8516
US

V. Phone/Fax

Practice location:
  • Phone: 985-981-5689
  • Fax:
Mailing address:
  • Phone: 985-981-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12627
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: