Individual
MR. CORNEILUS NATHANIEL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MFT
Contact information
Practice address
6173 UPLAND ST, PHILADELPHIA, PA 19142-2428
(267) 343-2080
Mailing address
6173 UPLAND ST, PHILADELPHIA, PA 19142-2428
(267) 343-2080
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
PA
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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