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General NPI Number Information
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NPI Number | 1346948734
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Entity Type | Individual
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Provider Name | ESSENCE KEASIA SMITH
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Gender | Female
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 1111 SPRINGDALE RD APT 105
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City | ROCK HILL
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State | SC
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Zip | 29730-7447
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Country | US
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Telephone | 803-579-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 SPRINGDALE RD APT 105
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City | ROCK HILL
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State | SC
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Zip | 29730-7447
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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