MEDICARE: MRS. YIASHA L SMITH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7531	SC

General Provider Information

NPI Number	:	1790284636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YIASHA L SMITH LPC

Provider Business Mailing Address
First Line	:	1340 N BRICKYARD RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-8015
Country	:	US
Telephone Number	:	180-376-0342
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 BROAD RIVER RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4012
Country	:	US
Telephone Number	:	803-000-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	12/11/2023

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