Provider Demographics
NPI:1902043797
Name:SMITH, EKIBA (MS)
Entity type:Individual
Prefix:MS
First Name:EKIBA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 BELLADONNA PL # 1018
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-5813
Mailing Address - Country:US
Mailing Address - Phone:407-676-4276
Mailing Address - Fax:
Practice Address - Street 1:1417 HAMLIN AVE UNIT G
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8590
Practice Address - Country:US
Practice Address - Phone:407-676-4276
Practice Address - Fax:407-794-9175
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health