Provider Demographics
NPI:1861078149
Name:SMITH, T'NA J
Entity type:Individual
Prefix:
First Name:T'NA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3205
Mailing Address - Country:US
Mailing Address - Phone:330-806-1133
Mailing Address - Fax:
Practice Address - Street 1:1527 4TH ST SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3205
Practice Address - Country:US
Practice Address - Phone:330-806-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician