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NPI Code Detail

MEDICARE: TARA VICTORIA SMITH

MEDICARE: TARA VICTORIA SMITH
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
11041C0700XClinical Social WorkerP017006NC
2104100000XSocial WorkerP017006NC

General Provider Information

NPI Number : 1881330777
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA VICTORIA SMITH
Provider Business Mailing Address
First Line : 2424 COMMERCE RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-7505
Country : US
Telephone Number : 252-557-0444
Fax Number : 252-557-0445
Provider Business Practice Location Address
First Line : 2424 COMMERCE RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-7505
Country : US
Telephone Number : 252-557-0444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2022
Last Update Date : 05/12/2022

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Directions to “ TARA VICTORIA SMITH ” Practice Location

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