Provider Demographics
NPI:1578295044
Name:SMITH, MARCIA DEMARJE
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:DEMARJE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12711 ALDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3937
Mailing Address - Country:US
Mailing Address - Phone:901-387-8644
Mailing Address - Fax:281-869-3693
Practice Address - Street 1:126 ELDRIDGE RD STE E
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3794
Practice Address - Country:US
Practice Address - Phone:281-907-9528
Practice Address - Fax:281-869-3696
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional