Provider Demographics
NPI:1922399674
Name:CHILDRESS-SMITH, HERNORIA PAL LEA
Entity type:Individual
Prefix:
First Name:HERNORIA
Middle Name:PAL LEA
Last Name:CHILDRESS-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 1:1946 ONA MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4867
Mailing Address - Country:US
Mailing Address - Phone:702-279-4974
Mailing Address - Fax:
Practice Address - Street 1:7013 FOSSIL RIM ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-4028
Practice Address - Country:US
Practice Address - Phone:702-573-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist