Healthcare Provider Details

I. General information

NPI: 1306093554
Provider Name (Legal Business Name): CURTIS O. SMITH LPC, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NORTH MAIN STREET, SUITE 2
KENANSVILLE NC
28349-9091
US

IV. Provider business mailing address

PO BOX 1576
ROSEBORO NC
28382-1576
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-6244
  • Fax:
Mailing address:
  • Phone: 910-296-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6940
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: