Provider Demographics
NPI:1023744216
Name:STILES-SMITH, BENITA L
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:L
Last Name:STILES-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MADISON 3275
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740-6983
Mailing Address - Country:US
Mailing Address - Phone:479-404-0303
Mailing Address - Fax:
Practice Address - Street 1:1014 MADISON 3275
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-6983
Practice Address - Country:US
Practice Address - Phone:479-232-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical