Provider Demographics
NPI:1215702816
Name:SMITH, ANNALEECE MARIE (RBT)
Entity type:Individual
Prefix:MRS
First Name:ANNALEECE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1220
Mailing Address - Country:US
Mailing Address - Phone:615-474-3767
Mailing Address - Fax:
Practice Address - Street 1:210 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1220
Practice Address - Country:US
Practice Address - Phone:615-474-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23-272438106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician