Healthcare Provider Details

I. General information

NPI: 1952052268
Provider Name (Legal Business Name): KELLY E SMOAK LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E TRADE ST
FOREST CITY NC
28043-3149
US

IV. Provider business mailing address

203 SHERWOOD DR
GAFFNEY SC
29340-2941
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-7871
  • Fax:
Mailing address:
  • Phone: 864-838-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017210
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: