Provider Demographics
NPI:1992784789
Name:SMITH, DONITA L (MSW; LCSW)
Entity type:Individual
Prefix:
First Name:DONITA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW; LCSW
Other - Prefix:
Other - First Name:DONITA
Other - Middle Name:L
Other - Last Name:EHRHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW; LCSW
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1197
Mailing Address - Country:US
Mailing Address - Phone:904-396-8750
Mailing Address - Fax:904-396-8759
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1197
Practice Address - Country:US
Practice Address - Phone:904-396-8750
Practice Address - Fax:904-396-8759
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497277004Medicaid
MO497277004Medicaid