Provider Demographics
NPI:1366157620
Name:SMITH, LISA KAY (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:SADEWHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:603 UPLAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6788
Mailing Address - Country:US
Mailing Address - Phone:573-489-9619
Mailing Address - Fax:
Practice Address - Street 1:603 UPLAND CREEK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6788
Practice Address - Country:US
Practice Address - Phone:573-489-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0005971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty