Provider Demographics
NPI:1124408190
Name:SMALLWOOD, RICHELLE LAFAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:LAFAYE
Last Name:SMALLWOOD
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 1:3340B ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4944
Mailing Address - Country:US
Mailing Address - Phone:252-917-8182
Mailing Address - Fax:
Practice Address - Street 1:3340B ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4944
Practice Address - Country:US
Practice Address - Phone:252-917-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0110041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19DCNOtherBCBS OF NC
NC1124408190Medicaid
NCQ58738BOtherMEDICARE