Healthcare Provider Details

I. General information

NPI: 1063641397
Provider Name (Legal Business Name): SYLVESTER R. SMITH MSRC; LPC, CRC, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 TAYLOR AVE
HIGH POINT NC
27260-7369
US

IV. Provider business mailing address

803 TAYLOR AVE
HIGH POINT NC
27260-7369
US

V. Phone/Fax

Practice location:
  • Phone: 336-689-3444
  • Fax: 336-886-1421
Mailing address:
  • Phone: 336-689-3444
  • Fax: 336-886-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8977
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number00112424
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number00112424
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8977
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: