=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457554065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA RENEE SMITH NCC, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 TRIAD CENTER DR SUITE 350
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27409-9073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-931-1823
-----------------------------------------------------
Fax | 336-931-1801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4284 7 LKS W 119 DENNIS CIRCLE
-----------------------------------------------------
City | WEST END
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27376-9306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-673-1377
-----------------------------------------------------
Fax | 910-673-1377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5241
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------