Provider Demographics
NPI:1114081668
Name:SMOLIN, ANN MICHELLE
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MICHELLE
Last Name:SMOLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:ISAACS-SMOLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4425 RANDOLPH RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2351
Mailing Address - Country:US
Mailing Address - Phone:704-576-7210
Mailing Address - Fax:704-362-1170
Practice Address - Street 1:4425 RANDOLPH RD
Practice Address - Street 2:SUITE 411
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2351
Practice Address - Country:US
Practice Address - Phone:704-576-7210
Practice Address - Fax:704-362-1170
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical