Provider Demographics
NPI:1144919325
Name:SMITH, LEICETA M (PCA/HHA)
Entity type:Individual
Prefix:MS
First Name:LEICETA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PCA/HHA
Other - Prefix:MR
Other - First Name:LEICETA
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCA
Mailing Address - Street 1:1624 LINKS OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3757
Mailing Address - Country:US
Mailing Address - Phone:347-573-4332
Mailing Address - Fax:
Practice Address - Street 1:1624 LINKS OVERLOOK
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3757
Practice Address - Country:US
Practice Address - Phone:347-573-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00691300374U00000X
372600000X, 376J00000X, 385H00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care