Provider Demographics
NPI:1962419598
Name:SMITH, MARIAN HAFTEL (LMHC, LPC)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:HAFTEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:MARION
Other - Middle Name:E
Other - Last Name:HAFTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LPC
Mailing Address - Street 1:468 SE EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6875
Mailing Address - Country:US
Mailing Address - Phone:904-206-0641
Mailing Address - Fax:904-491-3337
Practice Address - Street 1:468 SE EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6875
Practice Address - Country:US
Practice Address - Phone:904-206-0641
Practice Address - Fax:904-491-3337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005597101YP2500X
FLMH5151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL759732100Medicaid