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General NPI Number Information
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NPI Number | 1457793176
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Entity Type | Individual
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Provider Name | MISS SHAMEKA RACHELLE SMITH
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 1550 UNION RD STE A
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City | GASTONIA
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State | NC
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Zip | 28054-5522
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Country | US
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Telephone | 704-482-2460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3703
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City | GASTONIA
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State | NC
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Zip | 28054-0038
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Country | US
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Telephone | 980-989-4453
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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 | C009681
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License Number State | NC
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