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NPI Code Detail

MEDICARE: AMANDA T SMITH LCAS

MEDICARE: AMANDA T SMITH LCAS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-20485NC

General Provider Information

NPI Number : 1710344486
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA T SMITH LCAS
Provider Business Mailing Address
First Line : 1101 CAROLINA ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1318
Country : US
Telephone Number : 336-333-6860
Fax Number : 336-275-1187
Provider Business Practice Location Address
First Line : 1101 CAROLINA ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-1318
Country : US
Telephone Number : 336-333-6860
Fax Number : 336-275-1187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2016
Last Update Date : 11/30/2021

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