Healthcare Provider Details

I. General information

NPI: 1700389236
Provider Name (Legal Business Name): TRAVIS SMELTZER MA, LCMHC, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 WRIGHTSVILLE AVE
WILMINGTON NC
28403-4111
US

IV. Provider business mailing address

3121 WRIGHTSVILLE AVE
WILMINGTON NC
28403-4111
US

V. Phone/Fax

Practice location:
  • Phone: 910-769-6053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-22570
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13916
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: