Provider Demographics
NPI:1376041020
Name:GIACCONE SMITH, RACHAEL (LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:
Last Name:GIACCONE SMITH
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:GIACCONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2212 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4228
Mailing Address - Country:US
Mailing Address - Phone:910-779-0454
Mailing Address - Fax:910-491-0833
Practice Address - Street 1:2212 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4228
Practice Address - Country:US
Practice Address - Phone:910-779-0454
Practice Address - Fax:910-491-0833
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15203101YM0800X
NCLCAS-22722101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health