Provider Demographics
NPI:1396354858
Name:HANCOCK-SMITH PEDIATRIC & BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:HANCOCK-SMITH PEDIATRIC & BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANYALIESE
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:HANCOCK-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-518-6006
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32616-0305
Mailing Address - Country:US
Mailing Address - Phone:386-518-6006
Mailing Address - Fax:385-518-6024
Practice Address - Street 1:13900 TECH CITY CIR STE 408
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6090
Practice Address - Country:US
Practice Address - Phone:386-518-6006
Practice Address - Fax:386-518-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health