Provider Demographics
NPI:1437880168
Name:SMITH, CONTESSA (CPSS)
Entity Type:Individual
Prefix:MS
First Name:CONTESSA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:MS
Other - First Name:CONTESSA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPSS
Mailing Address - Street 1:1535 DARIEN BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-1910
Mailing Address - Country:US
Mailing Address - Phone:336-920-6698
Mailing Address - Fax:
Practice Address - Street 1:1535 DARIEN BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1910
Practice Address - Country:US
Practice Address - Phone:336-920-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist