Provider Demographics
NPI:1447935440
Name:SMITH, KATRINA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 LANDMARK LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2913
Mailing Address - Country:US
Mailing Address - Phone:585-610-5200
Mailing Address - Fax:
Practice Address - Street 1:4906 LANDMARK LN
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2913
Practice Address - Country:US
Practice Address - Phone:585-610-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional