Provider Demographics
NPI:1235950858
Name:SMALLS, MARIA D (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:SMALLS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 NOTTINGHAM DR APT 31
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-8368
Mailing Address - Country:US
Mailing Address - Phone:484-347-6108
Mailing Address - Fax:
Practice Address - Street 1:913 NOTTINGHAM DR APT 31
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-8368
Practice Address - Country:US
Practice Address - Phone:484-347-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20660101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor