Provider Demographics
NPI:1366883373
Name:SMITH, DEONDRA LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:DEONDRA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92181
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-2181
Mailing Address - Country:US
Mailing Address - Phone:337-349-8902
Mailing Address - Fax:337-408-3964
Practice Address - Street 1:2448 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2756
Practice Address - Country:US
Practice Address - Phone:337-233-7250
Practice Address - Fax:337-233-7104
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4513101YP2500X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor