Provider Demographics
NPI:1073667655
Name:KROLL-SMITH, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KROLL-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 D WEST MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1399
Mailing Address - Country:US
Mailing Address - Phone:336-312-1804
Mailing Address - Fax:336-323-1615
Practice Address - Street 1:3707 D WEST MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1399
Practice Address - Country:US
Practice Address - Phone:336-312-1804
Practice Address - Fax:336-323-1615
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133MEOtherNC BCBS
NC6002634Medicaid
NC133MEOtherNC BCBS