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: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 N CASWELL RD
CHARLOTTE NC
28204-2442
US

IV. Provider business mailing address

415 ANNABERG LN
MONROE NC
28110-8655
US

V. Phone/Fax

Practice location:
  • Phone: 704-765-2549
  • Fax:
Mailing address:
  • Phone: 859-539-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: