Provider Demographics
NPI:1326101429
Name:SMETAK, KRIS BRYAN (LCMHC)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:BRYAN
Last Name:SMETAK
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 MAJESTIC CT STE 6
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5152
Mailing Address - Country:US
Mailing Address - Phone:704-674-7290
Mailing Address - Fax:704-396-6547
Practice Address - Street 1:839 MAJESTIC CT STE 6
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5152
Practice Address - Country:US
Practice Address - Phone:704-674-7290
Practice Address - Fax:704-396-6547
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5347101YM0800X, 101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103254Medicaid
NC8300014Medicaid
NC6005887Medicaid