Provider Demographics
NPI:1063641397
Name:SMITH, SYLVESTER R (MSRC; LPC, CRC, LCAS)
Entity Type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSRC; LPC, CRC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-7369
Mailing Address - Country:US
Mailing Address - Phone:336-689-3444
Mailing Address - Fax:336-886-1421
Practice Address - Street 1:803 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-7369
Practice Address - Country:US
Practice Address - Phone:336-689-3444
Practice Address - Fax:336-886-1421
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8977101YP2500X, 101YM0800X
NC00112424103TM1800X, 103TR0400X
NC20131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6115154OtherNORTH CAROLINA HEALTH CHOICE
NC6115154Medicaid