Basic Information
| Provider Information | |||||||||
| NPI: | 1104308287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CASSIEL | ||||||||
| MiddleName: | SUNDIATA STERLING | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPCA, LCASA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 COPPERFIELD BLVD NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047823131 | ||||||||
| FaxNumber: | 7047823133 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 COPPERFIELD BLVD NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047823131 | ||||||||
| FaxNumber: | 7047823133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2018 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A14187 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 24205 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.