Healthcare Provider Details

I. General information

NPI: 1982738613
Provider Name (Legal Business Name): EMILY SMITH GODFREY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CABIN CREEK RD
MOORESVILLE NC
28115-9503
US

IV. Provider business mailing address

280 CABIN CREEK RD
MOORESVILLE NC
28115-9503
US

V. Phone/Fax

Practice location:
  • Phone: 704-855-1704
  • Fax:
Mailing address:
  • Phone: 704-855-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004244
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: