MEDICARE: KAREN DENISE SMITH LCSW

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	1041C0700X	Clinical Social Worker	C005023	NC

General Provider Information

NPI Number	:	1093953242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DENISE SMITH LCSW

Provider Business Mailing Address
First Line	:	685 OAK HILL RD
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-7079
Country	:	US
Telephone Number	:	919-942-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 HOPE MILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4234
Country	:	US
Telephone Number	:	910-491-6011
Fax Number	:

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

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	12/16/2019

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