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General NPI Number Information
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NPI Number | 1407990351
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Entity Type | Individual
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Provider Name | FAISON HEATHMAN SMITH IV LCDC, ADCIII
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 801 W NOLANA AVE SUITE 101
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City | MCALLEN
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State | TX
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Zip | 78504-3034
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Country | US
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Telephone | 956-994-1428
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Fax | 956-994-1487
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Provider Business Mailing Address
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Address Line | 3216 SWALLOW AVE
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City | MCALLEN
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State | TX
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Zip | 78504-4925
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Country | US
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Telephone | 956-630-3405
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1765
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License Number State | TX
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