Provider Demographics
NPI:1003405408
Name:SMITH, JENNIFER MARIE (LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8562 NC HIGHWAY 105 S UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7879
Mailing Address - Country:US
Mailing Address - Phone:919-760-5977
Mailing Address - Fax:855-404-4030
Practice Address - Street 1:8562 NC HIGHWAY 105 S UNIT 102
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7879
Practice Address - Country:US
Practice Address - Phone:828-333-4170
Practice Address - Fax:855-404-4030
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO141921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical