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NPI Code Detail

MEDICARE: TRIA SMOTHERS LCMHC-A

MEDICARE: TRIA SMOTHERS LCMHC-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorA16321NC

General Provider Information

NPI Number : 1013508290
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRIA SMOTHERS LCMHC-A
Provider Business Mailing Address
First Line : 201 DAVELYN CT
Second Line :
City : GARNER
State : NC
Zip : 27529-6048
Country : US
Telephone Number : 443-527-8675
Fax Number :
Provider Business Practice Location Address
First Line : 5401 SIX FORKS RD
Second Line :
City : RALEIGH
State : NC
Zip : 27609-4462
Country : US
Telephone Number : 919-886-4052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2021
Last Update Date : 01/29/2021

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