Healthcare Provider Details

I. General information

NPI: 1326101429
Provider Name (Legal Business Name): KRIS BRYAN SMETAK LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/28/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLENWAY ST STE F
BELMONT NC
28012-3174
US

IV. Provider business mailing address

100 GLENWAY ST STE F
BELMONT NC
28012-3174
US

V. Phone/Fax

Practice location:
  • Phone: 704-674-7290
  • Fax: 704-461-8989
Mailing address:
  • Phone: 704-674-7290
  • Fax: 704-461-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5347
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number5347
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5347
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: