Provider Demographics
NPI:1093188377
Name:SMITH, SHARLICE M (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SHARLICE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 MECHANICSVILLE RUN LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6359
Mailing Address - Country:US
Mailing Address - Phone:919-559-6544
Mailing Address - Fax:888-263-6314
Practice Address - Street 1:150 E ARLINGTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5019
Practice Address - Country:US
Practice Address - Phone:252-758-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty