Healthcare Provider Details

I. General information

NPI: 1588753347
Provider Name (Legal Business Name): LISA SMART ANDERSON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 PINEHURST AVE J
SOUTHERN PINES NC
28387-6352
US

IV. Provider business mailing address

973 BLACKEYED SUSAN PL
VASS NC
28394-8412
US

V. Phone/Fax

Practice location:
  • Phone: 910-693-7777
  • Fax: 910-693-1524
Mailing address:
  • Phone: 910-245-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC003019
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: