Healthcare Provider Details

I. General information

NPI: 1508175142
Provider Name (Legal Business Name): SARAH ELIZABETH SMEAD ED.S., LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ELIZABETH JOHNSON EDS

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 FAIRVIEW RD STE 240
CHARLOTTE NC
28210-3138
US

IV. Provider business mailing address

5950 FAIRVIEW RD STE 240
CHARLOTTE NC
28210-3138
US

V. Phone/Fax

Practice location:
  • Phone: 704-765-2549
  • Fax: 704-765-4749
Mailing address:
  • Phone: 704-765-2549
  • Fax: 704-765-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4899
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4190736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: