MEDICARE: MRS. LINDA M SMITH MA, LPC, NCC

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
1	101YP2500X	Professional Counselor	3855	NC

General Provider Information

NPI Number	:	1437108651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA M SMITH MA, LPC, NCC

Provider Business Mailing Address
First Line	:	6845 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3363
Country	:	US
Telephone Number	:	704-364-4333
Fax Number	:	704-969-1175

Provider Business Practice Location Address
First Line	:	6845 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3363
Country	:	US
Telephone Number	:	704-364-4333
Fax Number	:	704-969-1175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/09/2007

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