Basic Information
| Provider Information | |||||||||
| NPI: | 1285277970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | LCMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6631 RUNNING FOX RD | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283482931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195889393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2212 HOPE MILLS RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107790454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2019 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A14934 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 14934 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.