Basic Information
| Provider Information | |||||||||
| NPI: | 1669555926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMART | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 ROCKY RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288062224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287751242 | ||||||||
| FaxNumber: | 8282984870 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 REDDICK RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288052717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287751242 | ||||||||
| FaxNumber: | 8282982870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 5145 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6103108 | 05 | NC | MEDICAID |