Provider Demographics
NPI:1497316012
Name:SMYTHE, SHANTEL LYNETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:LYNETTE
Last Name:SMYTHE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S SHARON AMITY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2836
Mailing Address - Country:US
Mailing Address - Phone:704-412-9891
Mailing Address - Fax:
Practice Address - Street 1:447 S SHARON AMITY RD STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:704-412-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001974106H00000X
NC2168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist