Healthcare Provider Details

I. General information

NPI: 1649312992
Provider Name (Legal Business Name): ANITA MICHELE SMITH M.ED., ED.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA MICHELE SMITH M.ED./ ED.S., LPC

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMPUS BOX ELON UNIVERSITY
GREENSBORO NC
27244
US

IV. Provider business mailing address

2040 CAMPUS BOX ELON UNIVERISTY
ELON NC
27244
US

V. Phone/Fax

Practice location:
  • Phone: 336-278-7822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5458
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5102
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: