Provider Demographics
NPI:1306559711
Name:SMITH, WANDA LEE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 PEERLESS ST APT 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3153
Mailing Address - Country:US
Mailing Address - Phone:281-682-0307
Mailing Address - Fax:
Practice Address - Street 1:7210 PEERLESS ST APT 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3153
Practice Address - Country:US
Practice Address - Phone:281-682-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor