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General NPI Number Information
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NPI Number | 1679117279
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Entity Type | Individual
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Provider Name | DEQUAN LAMAR SMITH BT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 800 OAK ST
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City | FARMVILLE
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State | VA
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Zip | 23901-1199
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Country | US
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Telephone | 434-201-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 SCOTTS CROSSROADS
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City | CHASE CITY
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State | VA
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Zip | 23924-3336
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Country | US
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Telephone | 434-210-8250
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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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