Healthcare Provider Details

I. General information

NPI: 1245594860
Provider Name (Legal Business Name): CHERIE MICHELE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 DANA DR
MEDINA TN
38355-8778
US

IV. Provider business mailing address

137 DANA DR
MEDINA TN
38355-8778
US

V. Phone/Fax

Practice location:
  • Phone: 731-343-4226
  • Fax:
Mailing address:
  • Phone: 731-343-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21119
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12761-C
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6166
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: