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General NPI Number Information
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NPI Number | 1467198499
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Entity Type | Individual
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Provider Name | MS. EBONE TENISHA SMITH
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 9451 COATS RD
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City | LINDEN
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State | NC
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Zip | 28356-9563
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Country | US
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Telephone | 910-694-8987
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 TOWN CENTER DR. SUITE 130 UNIT #142
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City | FAYETTEVILLE
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State | NC
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Zip | 28306
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Country | US
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Telephone | 910-694-8987
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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