Healthcare Provider Details

I. General information

NPI: 1417548611
Provider Name (Legal Business Name): PASSION SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SPENCE AVE
GOLDSBORO NC
27534-4553
US

IV. Provider business mailing address

207 S SPENCE AVE
GOLDSBORO NC
27534-4553
US

V. Phone/Fax

Practice location:
  • Phone: 919-394-5363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP023677
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: