Provider Demographics
NPI:1588440044
Name:SMITH, BRIANNA DIONNE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DIONNE
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 1:14206 SANTA ANNA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6578
Mailing Address - Country:US
Mailing Address - Phone:803-603-8668
Mailing Address - Fax:
Practice Address - Street 1:14206 SANTA ANNA WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6578
Practice Address - Country:US
Practice Address - Phone:803-603-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician