Provider Demographics
NPI:1881363679
Name:SMITH, LONTISHA (MHA)
Entity type:Individual
Prefix:
First Name:LONTISHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2391
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2391
Mailing Address - Country:US
Mailing Address - Phone:864-764-8733
Mailing Address - Fax:
Practice Address - Street 1:145 N CHURCH ST STE B102
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5144
Practice Address - Country:US
Practice Address - Phone:864-767-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1562251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health