Provider Demographics
NPI:1376587964
Name:SMITH, CHERYL DELILA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DELILA
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 1:29393 NELSON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-7520
Mailing Address - Country:US
Mailing Address - Phone:704-763-3353
Mailing Address - Fax:
Practice Address - Street 1:29393 NELSON MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-7520
Practice Address - Country:US
Practice Address - Phone:704-763-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342249OtherGROUP MEDICARE