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General NPI Number Information
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NPI Number | 1063324564
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Entity Type | Individual
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Provider Name | LATOYA CAMELIA THOMAS-SMILEY
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Gender | Female
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Dates
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Enumeration Date | 09/19/2026
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Last Update Date | 09/19/2026
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Provider Practice Location Address
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Address Line | 10152 W SANTIAGO DR
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City | ARIZONA CITY
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State | AZ
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Zip | 85123-5809
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Country | US
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Telephone | 850-730-9416
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Fax |
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Provider Business Mailing Address
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Address Line | 10152 W SANTIAGO DR P.O BOX 5506
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City | ARIZONA CITY
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State | AZ
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Zip | 85123-5809
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Country | US
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Telephone | 850-730-9416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | BHRF20208
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License Number State | AZ
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