Provider Demographics
NPI:1285876763
Name:SMITH, JOSHUA DE'VON (MA, DPC, LPC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DE'VON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, DPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10632
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-0632
Mailing Address - Country:US
Mailing Address - Phone:601-292-2107
Mailing Address - Fax:
Practice Address - Street 1:1520 29TH AVE STE 32
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2843
Practice Address - Country:US
Practice Address - Phone:601-292-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid