Healthcare Provider Details

I. General information

NPI: 1861078149
Provider Name (Legal Business Name): T'NA J SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 4TH ST SE
CANTON OH
44707-3205
US

IV. Provider business mailing address

1527 4TH ST SE
CANTON OH
44707-3205
US

V. Phone/Fax

Practice location:
  • Phone: 330-806-1133
  • Fax:
Mailing address:
  • Phone: 330-806-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
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: