Provider Demographics
NPI:1902330590
Name:LAMARRA SMITH, NICOLE (MS, MHC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:LAMARRA SMITH
Suffix:
Gender:F
Credentials:MS, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W RED BANK AVE
Mailing Address - Street 2:Q8
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4950
Mailing Address - Country:US
Mailing Address - Phone:609-519-7909
Mailing Address - Fax:
Practice Address - Street 1:701 W RED BANK AVE
Practice Address - Street 2:Q8
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-4950
Practice Address - Country:US
Practice Address - Phone:609-519-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLO3385916155716OtherLICENSE