Healthcare Provider Details

I. General information

NPI: 1861842221
Provider Name (Legal Business Name): JESSICA PLEMMONS SMITH LCAS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 NEW COLONY DR
WILMINGTON NC
28412-2045
US

IV. Provider business mailing address

3733 NEW COLONY DR
WILMINGTON NC
28412-2045
US

V. Phone/Fax

Practice location:
  • Phone: 910-489-9899
  • Fax:
Mailing address:
  • Phone: 910-489-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20171
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10118
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: