MEDICARE: STEPHANIE SMITH BCBA

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	103K00000X	Behavior Analyst	1-21-49145	NC
2	106S00000X	Behavior Technician	RBT-18-69642	NC

General Provider Information

NPI Number	:	1902374580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SMITH BCBA

Provider Business Mailing Address
First Line	:	814 TYVOLA RD STE 126
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3539
Country	:	US
Telephone Number	:	980-785-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CROWNPOINT EXECUTIVE DR STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-6725
Country	:	US
Telephone Number	:	704-708-8314
Fax Number	:	704-708-8315

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

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	12/22/2025

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Directions to “ STEPHANIE SMITH BCBA” Practice Location

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