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General NPI Number Information
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NPI Number | 1841853306
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Entity Type | Individual
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Provider Name | KELVIN MARTIN SMITH CIT
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Gender | Male
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 21089 SOUTH FRONTAGE ROAD
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City | LACASSINE
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State | LA
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Zip | 70650
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Country | US
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Telephone | 337-936-9197
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Fax | 337-588-4179
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Provider Business Mailing Address
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Address Line | 105 REBECCA DR
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City | LAFAYETTE
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State | LA
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Zip | 70508-5965
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Country | US
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Telephone | 337-661-4245
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Fax | 337-588-4179
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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 | 4238
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License Number State | LA
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