MEDICARE: ORRONDA SAMONE 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	101Y00000X	Counselor	20251392401	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	20251392401	NC
3	101YM0800X	Mental Health Counselor	20251392401	NC
4	101YP2500X	Professional Counselor	20251392401	NC
5	175T00000X	Peer Specialist	20251392401	NC

General Provider Information

NPI Number	:	1750278438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORRONDA SAMONE SMITH

Provider Business Mailing Address
First Line	:	401 HAWTHORNE LN STE 110
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2358
Country	:	US
Telephone Number	:	843-478-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 HAWTHORNE LN STE 110
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2358
Country	:	US
Telephone Number	:	843-478-2811
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/26/2025

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