Healthcare Provider Details

I. General information

NPI: 1891260261
Provider Name (Legal Business Name): SYDNEY C SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY GOEBELBECKER

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 SPRUILL AVE
NORTH CHARLESTON SC
29405-4764
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 702
NASHVILLE TN
37217-2679
US

V. Phone/Fax

Practice location:
  • Phone: 843-352-7049
  • Fax: 615-815-1946
Mailing address:
  • Phone: 615-361-4000
  • Fax: 615-815-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64944
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-73197
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: