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General NPI Number Information
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NPI Number | 1790799138
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Entity Type | Individual
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Provider Name | CHRISTINE ANNETTE SMOTHERS L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 127 GARY ST
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City | GULFPORT
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State | MS
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Zip | 39503-3503
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Country | US
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Telephone | 228-328-1202
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Fax | 228-328-2522
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Provider Business Mailing Address
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Address Line | 10723 LILINOE WAY
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-4336
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Country | US
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Telephone | 228-255-3719
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0582
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License Number State | MS
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