Healthcare Provider Details

I. General information

NPI: 1326218991
Provider Name (Legal Business Name): RONNIE COLMAN SMITH MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N GLENN ENGLISH ST
CORDELL OK
73632-2015
US

IV. Provider business mailing address

716 E 11TH STREET
CORDELL OK
73632
US

V. Phone/Fax

Practice location:
  • Phone: 703-980-8908
  • Fax:
Mailing address:
  • Phone: 703-980-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7441
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4430
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: