Individual
MS. MARIA L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, C-FNP, LPC
Contact information
Practice address
103 SOUTHLAKE CIR, CANTON, MS 39046-5369
(601) 824-0342
Mailing address
1101 KENWOOD PL, JACKSON, MS 39202-2432
(601) 951-0493
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1056
MS
363LF0000X
Family Nurse Practitioner
902088
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902088
MS
Other
Enumeration date
11/15/2010
Last updated
10/14/2022
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