Provider Demographics
NPI:1285348722
Name:SMITH-HAMMOCK, FAYSHA (LPC)
Entity type:Individual
Prefix:
First Name:FAYSHA
Middle Name:
Last Name:SMITH-HAMMOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4995
Mailing Address - Country:US
Mailing Address - Phone:501-442-9491
Mailing Address - Fax:
Practice Address - Street 1:420 HAWKINS RUN RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6654
Practice Address - Country:US
Practice Address - Phone:214-530-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional