Provider Demographics
NPI:1962542027
Name:SMITH, JONATHAN HILLEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:HILLEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 CHANNEL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5613
Mailing Address - Country:US
Mailing Address - Phone:423-499-9335
Mailing Address - Fax:
Practice Address - Street 1:105 LEE PARKWAY DR
Practice Address - Street 2:SUITE H & I
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6708
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48231041C0700X
NC0054751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical