Basic Information
| Provider Information | |||||||||
| NPI: | 1770080590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | AISHA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 E OAK ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347444537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079338331 | ||||||||
| FaxNumber: | 4079449471 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 E OAK ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347444537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079338331 | ||||||||
| FaxNumber: | 4079449471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | FL | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.