Provider Demographics
NPI:1205189958
Name:SMITH, SCOTT ALAN (MA, LPC, LCAS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1831
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1000 N 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2833
Practice Address - Country:US
Practice Address - Phone:704-983-2117
Practice Address - Fax:704-983-2636
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16227101YA0400X
NC9795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205189958OtherMAGELLAN
NC1205189958OtherBLUE CROSS BLUE SHIELD
NC1205189958Medicaid
NC1205189958OtherUNITED HEALTHCARE
NC1205189958OtherHUMANA