Provider Demographics
NPI:1154168623
Name:SMITH, RODRICK
Entity type:Individual
Prefix:
First Name:RODRICK
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CROSSVIEW PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6623
Mailing Address - Country:US
Mailing Address - Phone:601-826-6251
Mailing Address - Fax:
Practice Address - Street 1:1867 CRANE RIDGE DR STE 150C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4982
Practice Address - Country:US
Practice Address - Phone:769-251-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health