Healthcare Provider Details

I. General information

NPI: 1093386864
Provider Name (Legal Business Name): CHARLOTTE ANN SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12569 S 2700 W
RIVERTON UT
84065-7182
US

IV. Provider business mailing address

12569 S 2700 W
RIVERTON UT
84065-7182
US

V. Phone/Fax

Practice location:
  • Phone: 801-209-9797
  • Fax: 801-206-3506
Mailing address:
  • Phone: 801-209-9797
  • Fax: 801-206-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number134233-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: