MEDICARE: MS. JASMINE R SMITH LCSWA

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	P011476	NC

General Provider Information

NPI Number	:	1871016303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMINE R SMITH LCSWA

Provider Business Mailing Address
First Line	:	2314 GOLDEN GATE DR APT F
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-4340
Country	:	US
Telephone Number	:	910-584-9115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CENTERVIEW DR STE 101
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3709
Country	:	US
Telephone Number	:	336-907-7819
Fax Number	:

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/17/2017

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