Provider Demographics
NPI:1982253985
Name:SMITH, VICKIE ELAINE (MRC, CRC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MRC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10554 COOKS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7453
Mailing Address - Country:US
Mailing Address - Phone:409-227-4757
Mailing Address - Fax:409-750-7677
Practice Address - Street 1:10554 COOKS LAKE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7453
Practice Address - Country:US
Practice Address - Phone:512-644-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407442901Medicaid