MEDICARE: LAURA ELIZABETH SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10173	SC

General Provider Information

NPI Number	:	1023893245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELIZABETH SMITH

Provider Business Mailing Address
First Line	:	2224 HENRY TECKLENBURG DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-7802
Country	:	US
Telephone Number	:	803-450-4751
Fax Number	:

Provider Business Practice Location Address
First Line	:	2224 HENRY TECKLENBURG DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-7802
Country	:	US
Telephone Number	:	803-450-4751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	09/18/2025

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