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General NPI Number Information
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NPI Number | 1912934662
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Entity Type | Individual
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Provider Name | BRENDA L SMITH ED.D. LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4010 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7000
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Country | US
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Telephone | 870-541-6008
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Fax | 870-541-6034
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Provider Business Mailing Address
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Address Line | 4010 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7000
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Country | US
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Telephone | 870-541-6008
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Fax | 870-541-6034
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 910C
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License Number State | AR
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