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NPI Code Detail

MEDICARE: DR. SELENA NICOLE SMITH LAPSW, LADACII, PH.D

MEDICARE: DR. SELENA NICOLE SMITH LAPSW, LADACII, PH.D
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1360TN
21041C0700XClinical Social WorkerCMSW0006120TN
31041C0700XClinical Social Worker155

General Provider Information

NPI Number : 1962549733
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SELENA NICOLE SMITH LAPSW, LADACII, PH.D
Provider Business Mailing Address
First Line : 5865 RIDGEWAY CENTER PKWY STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-4014
Country : US
Telephone Number : 901-672-7857
Fax Number : 615-658-4559
Provider Business Practice Location Address
First Line : 5865 RIDGEWAY CENTER PKWY STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-4014
Country : US
Telephone Number : 901-672-7857
Fax Number : 615-658-7857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 02/19/2021

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