Individual
MARY OLIVIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(904) 396-8750
Mailing address
4161 CARMICHAEL AVE, BUILDING 3300, SUITE 150, JACKSONVILLE, FL 32207-2353
(904) 396-8750
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ISW 11471
DEPARTMENT OF HEALTH, DIV OF MEDICAL QUALITY ASSURANCE
FL
01
—
SW16181
LCSW
FL
Enumeration date
01/25/2017
Last updated
03/26/2019
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