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NPI Code Detail

MEDICARE: SHANNON MICHELLE SMITH LCMHCA

MEDICARE: SHANNON MICHELLE SMITH LCMHCA
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 CounselorA15828NC

General Provider Information

NPI Number : 1699383471
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MICHELLE SMITH LCMHCA
Provider Business Mailing Address
First Line : 10700 SIKES PL STE 325
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8208
Country : US
Telephone Number : 704-995-7312
Fax Number : 704-912-1614
Provider Business Practice Location Address
First Line : 10700 SIKES PL STE 325
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8208
Country : US
Telephone Number : 704-995-7312
Fax Number : 704-912-1614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2020
Last Update Date : 07/17/2020

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Directions to “ SHANNON MICHELLE SMITH LCMHCA” Practice Location

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