Healthcare Provider Details

I. General information

NPI: 1265446777
Provider Name (Legal Business Name): CHAKA P SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SENTINEL RDG
BELTON SC
29627-8280
US

IV. Provider business mailing address

112 SENTINEL RDG
BELTON SC
29627-8280
US

V. Phone/Fax

Practice location:
  • Phone: 864-351-9434
  • Fax:
Mailing address:
  • Phone: 864-351-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5343
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: