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General NPI Number Information
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NPI Number | 1336826643
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Entity Type | Individual
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Provider Name | MAMIE CHAVON SMITH LCSWA
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Gender | Female
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 364 RALEIGH ST
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-9047
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Country | US
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Telephone | 919-647-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 616 EPPSFIELD LN
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-5198
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Country | US
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Telephone | 910-544-9793
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P010858
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License Number State | NC
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