Provider Demographics
NPI:1447389853
Name:SMITH, ROBERT LAMONT SR (MSW, LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LAMONT
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:MSW, LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-0254
Mailing Address - Country:US
Mailing Address - Phone:910-848-1638
Mailing Address - Fax:910-848-1639
Practice Address - Street 1:402 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3112
Practice Address - Country:US
Practice Address - Phone:910-848-1638
Practice Address - Fax:910-848-1639
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1054101YA0400X
SC11041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6111911Medicaid
NC6111911Medicaid