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General NPI Number Information
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NPI Number | 1265002752
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Entity Type | Individual
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Provider Name | JEFFREY SMITH LCAS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 3826 BLAND RD
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City | RALEIGH
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State | NC
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Zip | 27609-6239
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Country | US
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Telephone | 919-872-1441
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Fax | 919-872-1455
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Provider Business Mailing Address
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Address Line | 3533 LIMBER LN
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City | RALEIGH
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State | NC
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Zip | 27616-8981
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Country | US
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Telephone | 919-426-4629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 27088
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License Number State | NC
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