Basic Information
| Provider Information | |||||||||
| NPI: | 1922649888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ISAAC | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | MSW, LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4330 VIOLA SIPE DR | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282563436 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 929 15TH ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286014162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282563436 | ||||||||
| FaxNumber: | 8282563623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | P013718 | NC | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | P013718 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.