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General NPI Number Information
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NPI Number | 1275160525
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Entity Type | Individual
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Provider Name | MIRIAM SMITH
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 4055 FABER PLACE DR STE 300
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-8524
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Country | US
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Telephone | 260-702-0360
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Fax | 803-658-0741
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Provider Business Mailing Address
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Address Line | 8 S TRACY ST
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City | CHARLESTON
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State | SC
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Zip | 29403-4720
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Country | US
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Telephone | 843-860-8316
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1051
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License Number State | SC
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