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Individual

SALLY NISSA SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LSW

Contact information

Practice address
8140 DREAM ST STE D, FLORENCE, KY 41042-7532
(513) 503-7544
Mailing address
3939 WOODGATE CT, ERLANGER, KY 41018-2923
(513) 503-7544

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
254374
KY

Other

Enumeration date
10/10/2019
Last updated
10/10/2019
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