Provider Demographics
NPI:1235525908
Name:SMITH, CHRISTIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name: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 1:405 GREYMIST DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7188
Mailing Address - Country:US
Mailing Address - Phone:919-448-7722
Mailing Address - Fax:919-869-1467
Practice Address - Street 1:3622 LYCKAN PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2564
Practice Address - Country:US
Practice Address - Phone:919-448-7722
Practice Address - Fax:919-869-1467
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0060521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical