Provider Demographics
NPI:1801306972
Name:SMITH, AWANNA LEIGH (LPC,MAC, LADAC, ADC,)
Entity type:Individual
Prefix:
First Name:AWANNA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC,MAC, LADAC, ADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6683
Mailing Address - Country:US
Mailing Address - Phone:479-725-5115
Mailing Address - Fax:479-750-4843
Practice Address - Street 1:4451 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7711
Practice Address - Country:US
Practice Address - Phone:870-630-3380
Practice Address - Fax:870-630-3892
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR401L101YA0400X
ARP2007041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)