Provider Demographics
NPI:1568848703
Name:SMITH, DEIDRA JAVEDA (LMFTA)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:JAVEDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 S MIAMI BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-4927
Mailing Address - Country:US
Mailing Address - Phone:919-572-8833
Mailing Address - Fax:
Practice Address - Street 1:2402 S MIAMI BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4927
Practice Address - Country:US
Practice Address - Phone:919-572-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10060A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist