Healthcare Provider Details

I. General information

NPI: 1134959562
Provider Name (Legal Business Name): ANNA ROSE SMITH LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

IV. Provider business mailing address

501 EASY ST
KANNAPOLIS NC
28027-4190
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-9741
  • Fax: 704-270-6213
Mailing address:
  • Phone: 701-650-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021071
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: