MEDICARE: SMITH ASSESSMENTS AND TREATMENT SERVICES, INC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MHL-016-029	NC

General Provider Information

NPI Number	:	1538438676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH ASSESSMENTS AND TREATMENT SERVICES, INC

Provider Business Mailing Address
First Line	:	3110 ARENDELL ST
Second Line	:	SUITE 4
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-6511
Country	:	US
Telephone Number	:	252-727-5488
Fax Number	:	252-727-5302

Provider Business Practice Location Address
First Line	:	3110 ARENDELL ST
Second Line	:	SUITE 4
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-6511
Country	:	US
Telephone Number	:	252-727-5488
Fax Number	:	252-727-5302

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MR. JOSE GUADALUPE CARREON
Credential	:	CCJP
Telephone Number	:	252-727-5488

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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