Provider Demographics
NPI:1225797699
Name:SMITH, VONNA JO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VONNA
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E HONDO AVE
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-3320
Mailing Address - Country:US
Mailing Address - Phone:830-224-0024
Mailing Address - Fax:830-224-0030
Practice Address - Street 1:612 E HONDO AVE
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-3320
Practice Address - Country:US
Practice Address - Phone:830-224-0024
Practice Address - Fax:830-224-0030
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2024-07-31
Deactivation Date:2022-07-06
Deactivation Code:
Reactivation Date:2022-07-28
Provider Licenses
StateLicense IDTaxonomies
TX67147104100000X, 1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker