Healthcare Provider Details

I. General information

NPI: 1437683059
Provider Name (Legal Business Name): CHARITY RAE JOSIE SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N CENTRAL AVE STE 700
PHOENIX AZ
85012-2806
US

IV. Provider business mailing address

3101 N CENTRAL AVE STE 500
PHOENIX AZ
85012-2639
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax: 602-257-8029
Mailing address:
  • Phone: 602-230-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLAC-18947
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-22439
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: