Provider Demographics
NPI:1073660643
Name:SMITH, LORICE GRADY (LIP/LPC-A/LCAS-A/LRT)
Entity Type:Individual
Prefix:MRS
First Name:LORICE
Middle Name:GRADY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LIP/LPC-A/LCAS-A/LRT
Other - Prefix:MRS
Other - First Name:LORICE
Other - Middle Name:
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA/LCASA/LIP/LRT
Mailing Address - Street 1:305 HUNTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8329
Mailing Address - Country:US
Mailing Address - Phone:919-988-9582
Mailing Address - Fax:
Practice Address - Street 1:305 HUNTERS CREEK DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8329
Practice Address - Country:US
Practice Address - Phone:919-920-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1116174400000X
NC3031-A101YA0400X
NCA-10224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)