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General NPI Number Information
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NPI Number | 1174835771
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Entity Type | Individual
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Provider Name | SARAH A SMITH MHR
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Gender | Female
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 463142 STATE ROAD 200
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City | YULEE
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State | FL
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Zip | 32097-5554
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Country | US
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Telephone | 904-225-8280
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Fax | 904-225-8232
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Provider Business Mailing Address
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Address Line | 463142 STATE ROAD 200
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City | YULEE
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State | FL
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Zip | 32097-5554
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Country | US
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Telephone | 904-225-8280
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Fax | 904-225-8232
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1061
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CBHCMS100160
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License Number State | FL
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